The Diseases: Pertussis, Tetanus, Diphtheria, Polio and Haemophilus influenzae B

Pertussis disease

Commonly known as whooping cough, pertussis is a significant disease in children and can be very serious and sometimes fatal in infants younger than 6 months. But due to things such as improved sanitation, the widespread availability of fresh, unspoiled, nutritious food, the use of antibiotics, modern methods of resuscitation and rehydration techniques, death is much less likely now than it was during or before the early part of the twentieth century. Pertussis can cause severe symptoms, some of which may be permanent. Pertussis vaccine can cause similar symptoms and reactions: high fever, convulsions, continuing seizures, mental retardation, learning disabilities and chronic illness. It has also caused deaths.

Several different pathogens mimic symptoms of pertussis including Bordatella parapertussis and B. holmseii and others such as influenza; if initially there is only a dry, persistent cough, this may be misinterpreted as an allergic reaction. Therefore, if confirmation is needed, testing has to be done. After an incubation period of 5-21 days, usually 7-14, the first signs of illness range from a minor cold and cough to symptoms similar to those of bronchitis or influenza: runny nose, sneezing, a dry cough, a slight fever and lack of appetite. These symptoms last another 10-15 days. It is during this period that a sample of excretions of the nose/throat must be taken if culture testing is to be done; by the time the illness has progressed to the characteristic “whooping” stage it is too late to sample. The “whoop” of pertussis disease is the noise made when the child draws in air following coughing spells lasting up to thirty seconds. These prolonged spells serve to bring up mucous from the bronchial tubes. If food has been eaten, it may be expelled along with the mucous. The cough causes wakefulness at night and the restriction of breathing it causes may give rise to panic. The “whooping” stage may last 20-30 days and it is during this stage of the entire 4-6 weeks of symptoms that the child especially needs a calming adult nearby. Fever during the “whooping” stage is abnormal and requires the attention of a health professional. During the last couple of weeks the “whoops” become less frequent, the child starts to regain weight lost and sleep becomes easier. However, up to a year after recovery a cough, cold or exposure to cigarette smoke may set off a series of “whoops”. Babies less than 3 months find it especially difficult to manage the coughing fits; they may develop cyanosis, a bluish colouring of the skin due to lack of oxygen in their blood. Complications such as pneumonia are more likely at this age. If known cases of pertussis are occurring in your area it is wise to ensure isolation of your baby from possible contacts and/ or limit any infection that may have begun with a prescribed antibiotic, usually erythromycin.⁽¹⁾

Since the bacterium associated with pertussis is spread by airborne droplets, the disease is contagious whenever there is coughing but the most infectious coughs are the milder ones, before the “whoops” begin. Pertussis is also spread through contact with items the ill person has contacted.

Tetanus

Tetanus differs from other childhood diseases for which there is a vaccine because it is caused by a bacterium which cannot live and reproduce in the presence of oxygen and therefore is not easily communicable. In fact, Clostridium tetani, the bacterium which releases the toxin that can cause tetanus can be found in our own bodies and yet not cause infection. And even if infection does develop, contrary to what you have likely been told, it usually doesn’t end in death.

Diphtheria

The 2005 PENTACEL® monograph told us that the bacterium associated with diphtheria “may be harboured in the nasopharynx, skin or other sites of asymptomatic carriers” and that “Routine immunization against diphtheria in infancy and childhood has been widely practiced in Canada since 1930….Only 1 or 2 cases have been reported annually in Canada in recent years…The case-fatality rate remains 5-10%, with the highest death rates in the very young and elderly.” As for pertussis, measles and scarlet fever, the death rate for diphtheria in North American children was steadily decreasing long before widespread vaccination was practiced. ⁽²⁾

Polio

As for tetanus, the dangers of polio are overrated, firstly because presence of polio virus in the body generally doesn’t result in symptoms and even when it does, the infection is usually non-paralytic, mild and self-limiting to the extent that it is difficult to imagine it being the same disease that has gained the infamous reputation. In fact, because it’s generally such a mild disease, it’s quite possible that disease due to polio virus disappeared in Canada and elsewhere largely because of increased human resistance to the virus over generations of exposure rather than any vaccination programs. As environments in developing parts of the world began to become more sanitized in the late 18th and early 19th centuries, opportunities for exposure to polio viruses diminished and epidemics arose. But even during major epidemics, less than 10% of those exposed had any symptoms and, of those, most were no more severe than the symptoms of a cold. Less than 1% developed paralysis; only half of those remained permanently paralyzed and only 3/8% (three-eighths of one percent) of all those exposed developed severe lifetime paralysis. ⁽³⁾ An interesting aspect of the history of polio is that it’s also quite possible that much of the disease that was thought to have been due solely to viruses was actually due to or encouraged by other factors including: intoxication from agricultural chemicals that have since been banned; lack of iodine (prior to its addition to salt); tonsillectomies which were very much “in fashion” during the years of the polio epidemics in the 1950′s; lack of breastfeeding, it having gone “out of fashion”, and its replacement with DDT-laced cow’s milk formula. ⁽⁴⁾

It is interesting to note that, while DDT was phased out in Canada in 1968, it is still widely used in developing countries where polio occurs and these countries are the targets of frequent “eradication” campaigns using the live oral polio vaccine which itself can cause polio.

The second way in which the threat of polio is overrated is that, with the exception of rare cases due to importation from other countries where polio epidemics still occur, Canada has not had polio for decades. Health Canada’s website tells us that the last case of home-grown wild (ie: not from vaccine) paralytic polio in Canada occurred in 1977. There were imported cases reported in 1978 and 1988 and two detections of imported wild virus that didn’t cause illness in 1993 and 1996. Canada, along with the rest of the American Region, was formally certified as polio-free in September 1994. For much more about Polio, please refer to our Polio section.

Haemophilus influenzae type b

When it was first discovered, Haemophilus influenza type b (hereafter called “Hib”) was thought to be the pathogen that caused influenza, hence its confusing name. Hib is actually a bacterium which can lead to invasive diseases, particularly bacterial meningitis, and has been a major form of bacterial meningitis affecting children under 5 yrs. It is spread by respiratory excretions through coughing and sneezing and by direct or indirect contact. The most common early symptoms of Hib disease are high fever, headache and vomiting; infants become irritable, inactive, feed poorly and vomit. Symptoms of Hib meningitis progress to a stiff neck or back; when this happens emergency medical attention is necessary. If not attended to promptly, a swift progression of symptoms can follow: convulsions, confusion, shock, coma and death, all within a few hours of the onset of symptoms. Aside from meningitis which can occur in 50-65% of all cases, complications of Hib disease include: epiglottitis (inflammation of the flap that closes off the windpipe when swallowing), affecting about 15% of children with Hib disease; septic arthritis (fever and joint inflammation), about 12%; cellulitis (skin infection), about 10%; pneumonia, about 15%; osteomyelitis (bone infection), about 3-4%; and bacteremia (blood infection), about 2-3%. When antibiotics became widely available in the 1950′s and ’60′s they were used to stop contagion and greatly reduce deaths. However, since children who recovered from Hib disease often had severe illness including mental retardation and epilepsy, it was deemed necessary to have a Hib vaccine. Several vaccines were developed and some abandoned before the one used in Pentacel was introduced in 1992. ⁽⁵⁾

Despite the long list of illnesses possible from Hib, research has shown that it resides harmlessly in the noses, throats and respiratory tracts of up to 90% of all healthy people; it is thought that most children have achieved such colonization and immunity by the time they are 5 yrs old. ⁽⁶⁾ At the beginning of the twentieth century Hib disease was rarer than it was in the latter half of that century when the number of vaccines given and rates of vaccination soared. In her 1993 book, Viera Scheibner asks “Why have developed countries experienced such an increase of invasive infections in the past 40 years?” She answers herself by explaining “According to Smith and Haynes (1972) a 399% increase in the incidence of invasive Hib infections was recorded from 1942-50 through 1951-59 to 1960-68. Similar trends were presented by Bjune et al (1991). The best demonstrable common factor in this period is a documented push for mass vaccination. This explanation is especially plausible since the number of cases has not increased in babies below three months of age since 1942! ….This clearly implicates DPT injections in the increase of Hib diseases.”

Canada began to report Hib in 1979 but from 1979 to and including 1985 only cases of meningitis were reported. As the graph above shows, during this period there were only 220 to 420 cases of Hib meningitis per year in Canada. According to Health Canada, at this time about two-thirds of all Hib diseases occurred in children younger than 18 mos and over 80% occurred in children younger than 5 yrs. In 1986 two important changes occurred: all types of invasive Hib disease began to be reported and the first Hib vaccine was introduced. However, this vaccine was found to be ineffective in children younger than 18 mos. Considering the 55% increase from 420 cases in 1985 to 650 cases in 1988 and knowing that only 35-50% of all Hib cases do not develop meningitis and, of those, not all develop invasive disease, it seems likely that some of the increase was due to an “unprotected period”, also referred to as a “negative phase” which occurs during the first week following Hib vaccination (see ‘Risks’ in the next section). In 1988 a second vaccine was introduced which, Health Canada now says “is currently not recommended in Canada because it induces antibody responses that are suboptimal”. Two more Hib vaccines introduced in 1991 were licensed for use in infants 2 mos or older, as was the forth version introduced in 1992 (the one used in Pentacel). By 1994, Hib disease had declined to fewer than 100 cases per year, the highest incidence still in infants. ⁽⁷⁾

References

1. The Vaccination Dilemma, 2002, edited by Christine Murphy: ‘Common Childhood Illnesses’ by M Gloecker, MD and W Goebel, MD; pgs 56-58.
   What Your Doctor May Not Tell You About Children’s Vaccinations, 2001, by Stephanie Cave, MD, FAAFP; pgs 136-137.
   Mosby Medical Encyclopedia, 1996: Signet.
   The Informed Parent, June 2000: ‘Whooping Cough: The Disease and the Vaccine’ by Dr Jayne Donegan, MB, DRCOG, DCH, MRCGP (also at Whale).
2. Health Progress, 1935–1945, 1948, Metropolitan Life Insurance Co; pg12.
3. Vaccinations: A Thoughtful Parent’s Guide, 2001, by Aviva Jill Romm; pgs 34, 76-77 and 227.
4. The Encyclopedia of Common Diseases, 1962, by J I Rodale, Editor-in-Chief, Rodale Books Inc; Section 53, ‘Polio”.
5. What Your Doctor May Not Tell You About Children’s Vaccinations; pgs 152-155.
   Vaccinations: A Thoughtful Parent’s Guide; pgs 81-82.
   English: Vaccine Preventable Diseases: Haemophilus influenzae type b, Health Canada
   French: Maladies évitables par la vaccination: Haemophilus influenzae de type b, Agence De Sante´ Publique du Canada
6. Vaccinations: A Thoughtful Parent’s Guide; pgs 81-82.
   What Your Doctor May Not Tell You About Children’s Vaccinations; pg 151.
7. Vaccine Preventable Diseases, Health Canada, PPHB, Division of Immunization and Respiratory Diseases: ‘Haemophilus influenzae type b’.