When I was born in 1956, whooping cough, or pertussis was a serious childhood illness that still killed kids. A bacterial disorder it often isn’t diagnosed until antibiotics are much less ineffective. I had whooping cough as a child so I know how awful it can be. I already had been diagnosed with asthma, and I spent weeks struggling to breathe. My coughing was extremely painful, and only narcotic laced cough syrups offered any relief, though I had to be carefully monitored because of the effects narcotics can have have one;s ability to breathe, especially in small children. No one knew why I got the disease but it was likely that I hadn’t received the vaccine yet as I was between three and four when I came down with my case. (the vaccine for pertussis was developed in the 30’s and was in widespread use by the 1940’s in most states).
Whooping cough had been believed by public health officials to be a thing of the past in the United States , since for decades almost all children have been vacinated, just as they receive vaccinations for measles, diphtheria, etc. Prior to use of the vaccine the US had more than 175,000 cases per year in the 1940’s. By 1970, that figure had dropped to 5,000. By the 1980’s the average was 2,900 cases a year or less than 1 per every 100,000 people. Unfortunately, that rate has climbed since the 90’s. By 2004, we had nearly 26,000 cases, still small based on a per capita basis but a troubling statistic nonetheless. In 2010, there were over 27,000 cases and here is the what the CDC reported about those cases:
Pertussis is an endemic (common) disease in the United States, with periodic epidemics every 3 to 5 years and frequent outbreaks. In 2010, 27,550 cases of pertussis were reported — and many more cases go unreported. The primary goal of pertussis outbreak control efforts is to decrease morbidity (amount of disease) and mortality (death) among infants; a secondary goal is to decrease morbidity among persons of all ages.
Pertussis outbreaks can be difficult to identify and manage. Other respiratory pathogens often cause clinical symptoms similar to pertussis, and co-circulation with other pathogens (bacterial and viral) does occur. In order to respond appropriately (e.g., provide appropriate antibiotic prophylaxis), it is important to confirm that B. pertussis is circulating in the outbreak setting and to determine whether other pathogens are contributing to the outbreak. Polymerase chain reaction (PCR) tests vary in specificity, so obtaining culture confirmation of pertussis for at least one suspicious case is recommended any time there is suspicion of a pertussis outbreak.
Institutional outbreaks of pertussis are common. Outbreaks at middle and high schools can occur as protection from childhood vaccines fades. In school outbreaks, prophylaxis is recommended for close classroom and team contacts — and the pertussis booster vaccine (Tdap) depending on age. Pertussis outbreaks in hospitals and other clinical settings can put infants and other patients at risk.
Since the vaccine does wear off over time, it is important to to have booster shots for re-teens and adolescents. Failure to do so can lead to outbreaks in institutional settings such as schools and hospitals.
Unfortunately, this year public health officials in Washington State are being forced to deal with an epidemic of whooping cough cases in large part because of heavy cuts to the state’s public health care budget:
Although no deaths have been reported so far this year, the state has declared an epidemic and public health officials say the numbers are staggering: 1,284 cases through early May, the most in at least three decades and 10 times last year’s total at this time, 128.
The response to the epidemic has been hampered by the recession, which has left state and local health departments on the front lines of defense weakened by years of sustained budget cuts. […]
State health officials estimate that because of incomplete testing and the assumption that many people with mild cases are not seeking medical treatment, perhaps as few as one in five pertussis cases is being recorded and tracked, suggesting that the outbreak is far more widespread than the numbers indicate.
The NY Times report cited above goes on to note that many local health departments, dealing with severe funding cuts since 2008 have had to reduce staff, in some counties by as much as half their former levels. Funding for preventive care programs according to the article “…are mostly gone.” And Washington State is not alone in seeing a rise in this life threatening illness. Vermont also has noted increased rates of whooping cough cases, and California has had outbreaks in recent years, as well. In fact, doctors and other public health officials from around the country in January 2011 were calling for increased funding to prevent increasing pertussis outbreaks:
A nationwide surge in cases of pertussis, also known as whooping cough, has local doctors and pharmacists pressing for broader immunization against the highly contagious, potentially deadly bacterial infection. […]
The disease has reached epidemic levels in California — more than 8,300 cases and 10 infant deaths in 2010, the most in 50 years, according to the U.S. Centers for Disease Control and Prevention.
States including Michigan, Ohio and South Carolina are also seeing outbreaks, and federal and state health officials are encouraging more vaccination. […]
In October the Advisory Committee on Immunization Practices — a committee of experts selected by the U.S. Department of Health and Human Services — called for expanded vaccinations against pertussis.
Unfortunately, our Republicans in Congress over the last decade have consistently voted for less funding for public health programs that provide preventive care. Indeed, as Joan McCarter pointed out in this post, Congressional Republicans once again voted to cut health care benefits in order to eliminate military spending cuts mandated by the compromise spending law to which they agreed last year which supposedly resolved the debt ceiling crisis:
On Thursday, in a razor-thin 218-199 vote of approval, the House passed another extreme bill that is destined to die: its Sequestration Replacement Act. The budget bill overrides steep cuts to defense spending that were set to begin in January 2013, taking the money out of food stamps, Medicaid, Meals on Wheels and a raft of programs that help the poor and elderly. The Act replaces $109 billion in defense cuts that were triggered last fall under the Budget Control Act, when the super committee failed to agree on a $1.2 trillion deficit reduction plan.
Included in the $113 billion in cuts are Medicaid programs, allowing states to drop people who would currently be eligible, including a lot children. Two of the programs that are targeted have increased insurance rates for children to unprecedented levels, but the Republicans voted to repeal money in the Affordable Care Act that has maintained Medicaid and CHIP funding, and a new program that has rewards states for connecting eligible children to coverage. While the bill overrides the automatic cuts to the Pentagon included in the Budget Control Act, it keeps the Medicare cuts that were written into the bill. Oh, and of course it zeroes out the Prevention and Public Health fund in the health care law …
Pertussis and other preventable infectious diseases do not just strike children. They can also be very damaging to adults as well, particularly elderly patients or those with compromised immune systems. Republicans are willing to put your health and the health of our elderly and children at greater risk for no reason other than to continue to offer the wealthiest people tax cuts and maintain absurd levels of defense spending that we cannot afford, much of which is unnecessary. They are not the party of fiscal responsibility. More and more we see that they are the Party of the Rich, and the Party of Death. Certainly their unprecedented attacks on health care programs such as the ACA, Medicare, Medicaid and preventive care for children and adults shows a shocking and, I would argue, a depraved indifference to the lives of anyone who is not funding their radical political agenda.
Expect to see ever increasing outbreaks of infectious diseases in the years to come that we once believed had been virtually eradicated in the years to come so long as they control even one house of Congress, much less the Presidency. And these diseases do not discriminate. Anyone can get them, regardless of race, gender, ethnicity, religion or sexual orientation. Just ask the people of Africa what living in countries that do not fund preventive care programs is like. At least in Africa those governments have an excuse: they often simply can’t afford good medical care for all their people. In America, however, we have no such excuse.
