Diphtheria, Tetanus, Pertussis Vaccine

I am reviewing Diphtheria, Tetanus, and Pertussis (whooping cough) together since you typically give them to babies as a group. There is no doubt that like every disease we vaccinate for that it is not good to get a severe case of it, but we have chosen to not to vaccinate for diseases that are a uncommon. This makes this vaccine particularly difficult to decide because we are really talking about three diseases, not just one.

Let's start by looking at them individually.

Diptheria

The Vaccine Book says, "Dihptheria is a very severe throat infection that is caused by a bacterium...The germ secretes a toxin that irritates the lining of th ethroat and upper  lungs, causing a severe coughing and breathing difficulty. The breathing passage becomes swollen and may close off altogether... Diphtheria is transmitted like the common cold."

It is not common in the United States. There are only about 5 cases each year and many years go by without any reported cases at all. It is more common in parts of Africa, Central and South America, Asia, South Pacific, Middle East, and Europe. About 10 percent of cases are fatal. In those cases, by the time the victims seek treatment (antitoxin) the disease had done too much damage.

Our Choice: Since Dihpheria is basically nonexistant in the US we will not be vaccinating for it. If we decide to travel to other parts of the world where it is more common when she is older, we may reconsider.

Tetanus

The Vaccine Books says, "Tetanus is an acute infectious disease that is caused by a bacterum () that lives in soil and on dirty, rusty metal and can also contaminate unsterile needles... the toxin that enters a person's a person's nerves and gradually caues paralysis throughtout the body. Tetanus is commonly referred to as lockjaw because often the first muscles to become paralyzed are the jaw muscles.

It is thankfully not common. Most people with deep and dirty wounds receive proper medical care and have their wounds flushed out with clean water and disinfectant. Each year in the United States we see only about 50 to 100 cases of tetanus. Virtually all occur in adults over twenty-five who haven't received a booster shot. Only about 1 case occurs in kids under five each year, and only a handful in older children. Before this vaccine was introduced several decades ago, about 1300 cases were reported each year in the United States." Internationally, tetanus is much more severe for infants says the World Health Organization that has reports of 200,000 infants dying each year from tetanus world wide. This occurs most often when an unvaccinated mom gives birth, the umbilical cord is cut with a dirty tool, and tetanus spores from the dirty tool flow into the newborn baby through the cord. This doesn't happen in developed countries.

Our Choice: Given that there is only 1 case for kids under 5 and a handful in older children we will not be vaccinating. I can see how some might think that vaccines caused the decline (1300 to 50 or 100 cases a year) in cases would be attributed to the vaccine. I think it is more about the decline of the family farm and everyone moving into cities where we don't routinely work in the dirt. In short Tetanus is not a disease of infants and rarely for children.

It has a 15% fatality rate. It is treatable with antibody injections and antibiotics to kill the germ, but there are no medications to reverse the paralyzsis. It just has to run its course which can mean intensive care and life support while the paralysis wears off. This may take a few weeks. Also, you can get the tetanus vaccine if you get injured and suspect you might get tetanus. It is however not as effective. Though, there is a TIG (tetanus immune globulin) that can immediately inactivate any tetanus bacteria present.

Pertussis

The Vaccine Books says, "Otherwise known as whooping cough, pertussis is caused by a bacterium (Bordetela pertussis) that infects the upper lungs. It secretes a toxin that causes severe irritation and damage to teh lining of the upper lungs and throat. Pertussis is similar to diphtheria, not as serious. Symptoms mimic the common cold in the first week, but then the cough worsens into prolonged coughing fits tha tlast from thirty seconds to as long as two minutes. The cough is so severe that a person can barely breathe, and when a breath is finally possible, it sounds like a gasping "whoop." Pertussis is transmitted like the common cold an dcan last for as long as three months, even with treatment."

According to The Vaccine Book, Unfortunately, Pertussis is fairly common (about 10,000 reported caes each year in the United States during the 1990s and early 2000). In 2004 and again in 2005 it increased to about 25,000. Over the past few decades pertussis has mysteriously peaked every five years (some other sources say 3-4 years) and then decline. Case in point, one year later in 2006, it was back down to 13,000 cases. In the early part of the twentieth century (before the pertussis vaccine ) cases where about 240,000 each year in the US.

From what I can tell it appears that the vaccine may have made a difference in reducing the overall number of cases. I still wonder what would have happened if we didn't vaccinate for it. Would it have grown out of control or just declined to is current state as many of the charts suggest diseases do naturally.

The Vaccine Book says, the greatest risk for infants is below 6 months with about 1% fatality rate for that age group. There are about 2000 reported cases of pertussis each year for infants less than 6 months, and about 75% are hospitalized and about 20 die each year. In rare cases the infant can have coughing fits so long the brain is deprived of oxygen and can cause brain damage. There appears to be no long term effect from this disease. The coughing slowly resolves and the lungs recover over a couple of months. After 6 months of age, fatalities are almost unheard of, so isn't considered a serious disease in older infants (meaning up to age 1), children, and adults.

It is treatable using antibiotics to kill the germs so the person is no longer contagious. However, the damage to the airway caused by the infection produces weeks of ongoing cough, even after the germs are gone. Starting treatment early may make the symptoms shorter or less severe. The problem is that since it can be mistaken for other things like just a cough treatment may come later when the treatment might not help much and disease will just need to run its course. The good news is there are homeopathic remedies that are considered to be more effective than traditional medicines by many.

Our Choice: Since Pertussis is fatal for only 1% of the cases and that is typically in very young babies. The biggest risk seems to be less than 2 months or less and then 6 months when it is no longer considered a serious disease since fatalities are basically unheard of. Given that our baby is one month a way from the six month mark and we do not use day care and are careful about anyone who has a cough and there are homeopathic remedies we don't feel the risk of this quite reactive vaccine is worth the risk.

The Vaccines

The hard decision for many is whether to vaccine for all three even if you feel some of the others are not needed. In our case, we didn't find the risk of any particular one enough to vaccinate even if it were separate, so thankfully the choice is easier for us.

Adults
It is is recommended that you get a booster shot called Tdap every ten years. It is said this is to better protect the babies since can't be vaccinated until after two months. The focus of this vaccine is on Tetanus (you can tell because the T is bigger than the other letters). This is basically what some refer to as herd immunity (needs to be 90% of the population to be effective). About 25% of patients have standard side effects for this adult/child vaccine. Headache and fatigue are most common (30-40%).

My Choice: Personally, I won't be getting my booster. It is interesting when you start to consider what you would do vs. what you would do to your child. Most adults don't get their boosters (me included) because they think the risk is low, but yet some will automatically give it to their baby.

The Vaccine
There are a few different manufacturers of the vaccine and each one has different issues. Some have more Aluminum that others and some have none. Unfortunately, the one that has less Aluminum has Mercury. Between the two I would be sure to pick one that doesn't have Mercury and has more Aluminum since Mercury is really bad, and Aluminum is assumed to be not such a big deal. They all have formaldehyde.

There used to be a lot of bad things reported about DTP which are said to not apply to the new DTaP that we give our babies. About 15% of babies have standard side effects from this vaccine. There are real serious reactions though like Guillain-Barre syndrome, brain damage, and other nerve dysfunctions, encephalopathy.

There are other forms of the vaccine also. Here are some of them and what they are generally used for:

• DT - It is recommended for infants and children. Some parents use for older children since Pertussis is not needed later except for herd immunity and the P part is suspected to be the part that most kids are sensitive to. It is not recommended to be used for older kids because they may react to the high D component.
• dT - similar to DT, but less diphtheria vaccine than tetanus vaccine and is used for older kids (age 7 and up) and adults.
• T - Commonly used if someone is injured who want a tetanus shot. It is not officially approved for kids of younger age yet, but doctors can do it if desired.

I think it is crazy that there are so many versions of this vaccine for different age groups. To me that says it is too reactive. If for example the DT has too much D component then why in the heck should it be ok to give it to infants that are WAY smaller. This makes no sense to me. The whole set of vaccines tells me that these vaccines are not a one size fits all and thus may be more reactive for my baby.