Reno County's Relentless Whooping Cough Outbreak And FDA's Tod Merkel's Advice In Light Of New Findings

Reno County health officials are looking into over 70 cases of suspected whooping cough and have urged every single resident who has been coughing for more than two weeks to get checked by their doctor. Reno County, Kansas is not the only area of the country dealing with a surge in pertussis lately; cases have been climbing in recent years. On July 27, KWCH reported that the health department reported that all of the confirmed cases were people who were fully vaccinated, mirroring the initial outbreak that occurred at a high school in Falmouth, Cape Cod, Massachusetts last fall and other pockets of outbreaks around the country. KWCH updated their story stating that Hutchinson Schools' spokesman, Ray Hemman, said that the district, located in Reno County and working closely with the Reno County health officials, has only heard of cases in vaccinated children during this specific outbreak of whooping cough.

The recent spikes in cases of whooping cough led to research that offered surprising facts about whooping cough and the pertussis vaccine that is currently used in the United States. U.S. children are given a less reactive vaccine today than earlier generations were given. This newer vaccine is called the acellular pertussis vaccine. It replaced the older vaccine, but, according to the FDA's Tod Merkel, the acellular vaccine is causing some problems. Kansas enjoys a very high rate of vaccination, but the vaccine itself is doing little to curb actual transmission, according to researchers.

"A lot of people who are parents today don't remember when whole cell vaccine was used," Tod J. Merkel, microbiologist with the Center for Biologics Evaluation and Research at the FDA explained. "It was a very reactive vaccine. Every infant vaccinated developed a very sore arm and many developed a mild fever and were irritable for the first 24 hours. Anyone with an irritable 2-month-old is not a happy parent. In a very small percentage of cases, they developed a high fever. It was not dangerous, but it was scary."

Merkel worked on a study that recently found that the newer whooping cough vaccine, while offering the child who receives it significant protection against symptoms, doesn't actually prevent whooping cough infection. Children who are given the whooping cough vaccine still carry the bacteria, but show milder -if any- symptoms. Unfortunately, according to the FDA's microbiologist, people who are vaccinated likely carry the bacteria for up to six weeks once infected, while people who aren't vaccinated only carry the bacteria half as long, according to the team's research. Merkel explained that, unfortunately, carrying the pertussis bacteria for twice as long increases the number of bacteria that are actually in the lungs "by over 100 fold."

"The observation that aP, which induces an immune response mismatched to that induced by natural infection, fails to prevent colonization or transmission provides a plausible explanation for the resurgence of pertussis and suggests that optimal control of pertussis will require the development of improved vaccines," Merkel and his co-authors wrote in PNAS.

This is why health officials are trying to urge everyone in Reno County to become vaccinated, according to a local news outlet. Hutch News paraphrased Merkel's warning to unvaccinated individuals.

"However, that also means, if exposed you can carry it without showing symptoms and as you move around in the population unaware, infecting others. Moreover, the longer you carry the bacteria, the more likely you will encounter someone not vaccinated, under vaccinated or immune compromised, he said."
The Reno County health officials urged people who suspect that they might have even mild symptoms of pertussis to avoid contact with unvaccinated people in case their mild symptoms are actually signs of a heavy whooping cough bacterial load. Even fully vaccinated people who seem as though they may only have a mild cold or bronchitis could actually be contagious with whooping cough and transmit the disease fully to an unvaccinated child, according to the FDA's new information.

Though for years, health officials suggested cocooning infants by vaccinating everyone around the newborn, now, Merkel stresses that since cocooning hasn't been proven to stop transmission to infants as once believed, pregnant women are urged to get vaccinated.

"What they really have focused on the last few years is trying to get women vaccinated during pregnancy," Merkel explained, also offering that mothers can pass antibodies from the vaccine onto their newborns through the placenta and offer their newborns a few months of protection against whooping cough. "Newborns are absolutely more susceptible. They're too young to be vaccinated, and their airways are very small. Almost all deaths we've seen in the U.S. are newborns, which of course is heartbreaking."

"Someone showing typical signs of having a cold – that's how pertussis starts – should probably get to a doctor sooner than later, so they can get an antibiotic," the FDA's microbiologist also warned. "If given early enough, it will prevent the severity of the symptoms and it will prevent transmission. Most people wait until they have the cough, and by then it's too late."

To make matters worse, it seems as though, as the bacteria has evolved to escape vaccine protection, there has been an "emergence of strains with increased pertussis toxin production," according to the journal of the American Society for Microbiology, leading to areas of more virulent bacteria. Some researchers believe that this evolution of the bacteria was responsible for the 2008-2010 whooping cough outbreak in Australia, according to the Journal of Infectious Disease.

Trends in the Netherlands also indicated that as the pertussis bacteria evolves, especially as a result of weaker vaccines, it can have greater pertussis toxin and the disease becomes even more dangerous to those infected, according to a paper published in Emerging Infectious Diseases. Tod Merkel says the answer is a new whooping cough vaccine, but that won't come soon enough for Reno County residents.

"The goal is to develop the next generation acellular, that's not reactive, but also protects against infection better than whole cell," Merkel explained. "Sadly, these things take time. We think in a year, or two, or maybe three, we'll have a good idea of what's needed. Then comes the testing phase, putting things together to see if it works the way we hope it works. The biggest problem with developing a new vaccine is that it's impossible to test the duration of immunity until we get out and use them. It takes five or 10 years for a single experiment on duration. That's a significant problem."

Reno County Health Department's Nick Baldetti warned that school is about to start back up again and officials are concerned that there will be a new "micro-outbreak" as students start passing around the pertussis bacteria, so early vaccination clinics are already underway in an attempt to prevent under-vaccinated, non-vaccinated, and even vaccinated children from suffering from the outward symptoms of whooping cough as they head back to school.

[Photo adapted, credit: Reno County, Google Street View, Pixabay]