Anybody else dealing with pertussis?

Skippingtowork · May 3, 2017

This is a minor rant, some facts, and mostly on topic: I think it is important to remember Biology and immune response. Memory B cells live in the lymphatic system, and live a long time. Memory B cells cannot be detected by examining your blood, i.e., blood titers. Remember, that's why tetorifice booster shots are needed every 10 years because by the time the Memory B cells got the message to make antibodies (in the blood) you'd be dead because your diaphragm muscle would lock up/contract/freeze. I don't think it's necessary to continue to vaccinate adults due to low titers for other diseases. And probably not healthy. Vaccination doesn't eradicate the disease. I know you all know this! It assists with mounting an immune response quicker. The diseases are still very present. And every person, depending on their own body, their health, their nutrition, their sleep quality/quantity, stress level affects how their body will respond to any incoming pathogen. It just seems like everyone has forgotten this. Two children with the same vaccinations will not have the same immune response when that pathogen is reintroduced. Take pertussis for example: Kid A might have congestion and minor cough for 3 days, Kid B will cough for two weeks and feel lousy. Both kids-same age-same vaccination schedule. Parents of both say, "my kid has cold." Well, they could have been exposed to pertussis. (I know this from experience BTW) In other words, pertussis is far more common than people realize/believe/think/understand. It's still out there, everywhere. We take care of ourselves and our children differently, we have different body chemistry, different lifestyles, activities, etc., that help or hinder our immune system. Last, the current plan to end federally funded school breakfast and lunch programs....Mind blowing. The government will pay to inject them, but won't pay for a basic need such as nutrition.

I'm not sure how to explain that to the baby in the hospital struggling in the hospital from pertussis, contracted from parent or grannie who just had a little cough which lasted weeks.

meanmaryjean, DNP, RN · May 3, 2017

Me too! I had the series 3 times - beginning of nursing school then when I started working at a hospital, they tested me and had me go thru the series 2 more times and never seroconverted.

SIX rubella immunizations later- I no longer work bedside.

**LibraSunCNM, BSN, MSN, CNM** · May 3, 2017

Scary. At my last job as a midwife, caring for a diverse group of women who come from all over the world, we started checking titers for not just rubella, as has been standard in pregnancy for many years, but also measles, mumps, and varicella. We have ended up picking up on tons of women who are non-immune to one or more of those 4, and giving the boosters after delivery. Our Tdap vaccine rate is pretty good too. It's humbling how grateful patients from third world countries are for access to vaccines, since they have actually witnessed first-hand the horrors of a lot of these illnesses.

djh123 · May 3, 2017

I think she's one of the outlying princesses on Game of Thrones. "Beware Pertussis and her legions!"

Elvish, BSN, DNP, RN, NP · May 4, 2017

Scary. At my last job as a midwife, caring for a diverse group of women who come from all over the world, we started checking titers for not just rubella, as has been standard in pregnancy for many years, but also measles, mumps, and varicella. We have ended up picking up on tons of women who are non-immune to one or more of those 4, and giving the boosters after delivery. Our Tdap vaccine rate is pretty good too. It's humbling how grateful patients from third world countries are for access to vaccines, since they have actually witnessed first-hand the horrors of a lot of these illnesses.

Yes, yes, yes! When I was in Nicaragua last year, parents there were HORRIFIED that some people opt out of vaccines for their kids. I saw people walking around there with post-polio syndrome whose knees bent 90 degrees opposite of the normal, if they could walk at all.

I'm part of a natural parenting group, because I believe in some crunch and have learned some cool natural cleaning and/or hygeine tips. But I am forever trying to explain to folks that YES, we know exactly how vaccines work. YES, we know who is at risk for what. YES, we know exactly what is in them. YES, we have given billions of doses. NO, they do not cause autism/autoimmune crap/pick your disease of the day. NO, a fever or a sore arm is not a reason to stop vaccinating. Better a little bit sick than a whole lot dead.

audreysmagic, RN · May 4, 2017

I'm not in the schools anymore currently, but a local district just had a mumps outbreak. MUMPS. I breathed a sigh of relief that this was, at the moment, not my problem, but I did have to be alert for a bit of any high-school aged kids from that area with similar symptoms who came to my unit. I even used the outbreak in a teaching project I did for nursing students on immunizations and how "herd immunity" fails if an increasing number of said herd fails to immunize.

audreysmagic, RN · May 4, 2017

Better a little bit sick than a whole lot dead.

THIS THIS THIS THIS.

Also, the "my child might get autism!" First - DEBUNKED. Second - are you honestly saying you'd rather have a child suffer a terrible, life-threatening disease and possibly DIE than be autistic? That's just so horribly insulting to anyone on the spectrum and the people who love them. I don't have many soapboxes, but that's one of mine.

quickkarma, BSN · May 4, 2017

I'm not sure how to explain that to the baby in the hospital struggling in the hospital from pertussis, contracted from parent or grannie who just had a little cough which lasted weeks.

Exactly. But the same holds true. I believe TEACHING is part of the solution. Masks should be sent home with all new borns and parents should be told to wear one or ask people to wear one if they are coughing. You can immunize all you want; your body is still going to mount an immune response and shed. Why don't people know this? Parents need to use precaution and protect and take care of their babies and themselves and taught the benefits of breast feeding or pumping. Their baby did not get pertussis because Granny didn't get her booster shot.

quickkarma, BSN · May 4, 2017

That is the sad part, break down in herd immunization causes those who may not have seroconverted to be infected.

Please explain this further.

Otherwise, No. The non-seroconversion causes the infection, or the rate of that particular person's immune response causes this. NOTE: Pertussis IgM and IgA antibodies will usually only be present a short time after vaccination or infection. Otherwise, immune response happens when the message gets sent to the lymph. The difference in people's immune system function determines infection. People are infected and show no signs of infection, but can still shed. Macrophages, neutrophils, natural killer cells, dendritic, Tcells (in lymph), Bcells (lymph). OMG, the list goes on. Our immune systems are complicated.

Example: CD4+ T cells are a major T cell subset that plays a central role in immune system function when naive CD4+ T cells differentiate into effector and/or memory cells after encountering their cognate antigen via antigen-presenting cells (APCs). The phenotypes of effector CD4+ T cells differ depending on the stimulating conditions and can be categorized into various lineages. In the lungs, DCs bridge innate and adaptive immunity, and depending on context, they also induce various CD4+ T cell responses to infectious agents. During steady state, the lung contains two major subsets of CD11chi conventional ©DCs (CD103âˆ’ CD11b+ cells in the lamina propria and CD103+CD11bâˆ’ cells in the epithelial layer). (C&P that!)

I'm writing this because parents are told, "As long as your family members have all had their DPT shot, your baby will be fine. "Cocoon affect." BS, make them cover their cough. Ask them not to cough. Ask them to wash their hands. Pertussis is extremely contagious and will continue to be contagious even if every single person-all 7billion of us were vaccinated!

To all the people who are asked to re-vaccinate themselves because their titers are low, tell them your immune response still resides in your B memory cells located in your lymph. Because it does. My apology if this upsets people but this is all way more complicated than anyone realizes. And six injections is not the answer. Not at all. I will stop now.

SassyTachyRN · May 4, 2017

I am another "lucky" one that has never seroconverted for the Hep B vaccine....I always have to sign that paper that says "yes I know I am at risk".

Same here!

Skippingtowork · May 5, 2017

Exactly. But the same holds true. I believe TEACHING is part of the solution. Masks should be sent home with all new borns and parents should be told to wear one or ask people to wear one if they are coughing. You can immunize all you want; your body is still going to mount an immune response and shed. Why don't people know this? Parents need to use precaution and protect and take care of their babies and themselves and taught the benefits of breast feeding or pumping. Their baby did not get pertussis because Granny didn't get her booster shot.

How did they get it? And what if granny never had any pertussis vaccine? There are many diseases which are declining in incidence due to vaccinations.

Elvish, BSN, DNP, RN, NP · May 6, 2017

Exactly. But the same holds true. I believe TEACHING is part of the solution. Masks should be sent home with all new borns and parents should be told to wear one or ask people to wear one if they are coughing. You can immunize all you want; your body is still going to mount an immune response and shed. Why don't people know this? Parents need to use precaution and protect and take care of their babies and themselves and taught the benefits of breast feeding or pumping. Their baby did not get pertussis because Granny didn't get her booster shot.

To address a couple points made here:

Most vaccines are not shed, and those that are (generally the live viruses) are not considered to be risky enough to present a contraindication for household contacts of immunocompromised persons.

The baby may very well have gotten pertussis from Granny who didn't get her booster - Granny may never have gotten the pertussis vax to begin with.