Health & Welfare | Daily Report

I heard that they are not going to giveAssisted living Newport Beach the shots for another month. Assisted living Orange County is getting shafted as a whole community. Assisted living Irvine will be getting the medication, along with Assisted living Orange County

You need to look at the concentration of unvaccinated children and of pertussis outbreaks at Waldorf schools, where it's trendy not to vaccinate. There's a history of outbreaks at those schools, which are mostly private (a few are charter, which are so-called public schools) and tend to cater to wealthy white families. That may explain why there are high numbers of unvaccinated children in wealthy white areas.

This article gives an incomplete picture of the whooping cough/pertussis problem. Several states are now experiencing high rates of pertussis, including Texas, Arizona, Michigan, Ohio and South Carolina. In Texas, the incidence per 100,000 is greater than that in California. Only California and South Carolina have declared epidemic levels (states set their own thresholds for epidemic). Nationally, pertussis incidence is still below the levels seen at this time last year. Second, pertussis is endemic despite very high US pediatric vaccination rates. There are several reasons for this. 1) The Pertussis component of DTaP vaccines is only 80-85% effective, according to the vaccine package inserts and vaccine immunity wanes over time (5-10 years) 2) Adults are frequent asymptomatic carriers of pertussis and adults have very low vaccination rates 3) The b. pertussis circulating strain has changed in the past few decades (from ptxP1 to ptxP3), resulting in a more virulent disease; some research suggests this change is the result of population-wide pertussis vaccination programs [Bordetella pertussis Strains with Increased Toxin Production Associated with Pertussis Resurgence. FR Mooi et al, Emergining Infectious Diseases, Vol. 15, No. 8, August 2009] 4) There are two bacteria responsible for whooping cough: b. pertussis and b. parapertussis. The DTaP vaccine targets b. pertussis and is ineffective against b. parapertussis. Because b. parapertussis is not deemed “reportable” by the CDC and is rarely tested for, it is unknown how many cases of whooping cough/pertussis derive from b. parapertussis. A recent paper suggests that high rates of b. pertussis vaccination lead to higher incidence of b. parapertussis [Acellular pertussis vaccination facilitates Bordetella parapertussis infection in a rodent model of bordetellosis. GH Long et al, Proc. R. Soc. B 7 July 2010 vol. 277 no. 1690 2017-2025] 5) At least 5 of the 6 California deaths in 2010 were Latino infants under 3 months of age. There is inconclusive evidence and some disagreement in the medical community about whether or not individuals of Hispanic ethnicity are more susceptible to pertussis complications. The CA Health Dept is currently targeting latino communities in its vaccination “outreach” campaign. http://www.rdmag.com/News/FeedsAP/2010/07/life-sciences-whooping-cough-o... Another problem is that symptoms of many other respiratory illnesses mimic those of whooping cough/pertussis. Because the definitive diagnostic test for pertussis (bacteriological culture) is time consuming and labor intensive to perform, the illness is often diagnosed based purely on clinical symptoms and/or “pcr” molecular testing, which is often inaccurate. http://query.nytimes.com/gst/fullpage.html?sec=health&res=9501E7DB1F30F9... The point is that pertussis is a complex subject with multiple factors affecting incidence rates. The data show very high rates of US pediatric vaccination and very low rates of adult vaccination. Because of point 2 above, Adults who criticize school vaccination exemptions should make sure they are up to date on their own pertussis vaccination as they may be an unknown source of pertussis. BTW, Table 3 of the JAMA article cited in this post is interesting as it shows many of the states with “easy” exemptions at the low end of pertussis incidence and many of the states with “difficult” exemptions at the high end of pertussis incidence. Kind of a “mixed bag”, as was the CA county data in the last CA Watch post on this subject.

One more quibble. This post states: "It is uniquely easy here [CA] for parents to cite personal beliefs as a basis for skipping routine vaccinations when kids enter kindergarten." California is hardly unique. 48 states offer religious exemptions, 19 offer personal belief exemptions. Table 3 of the JAMA article cited in this post shows several states with "easy" exemptions. US pediatric vaccination coverage rates are currently at an all time high.

There is a disproportionately larger number of pertussis incidence and mortality in individuals of Hispanic ethnicity. In a June, 2010 bulletin the CDPH says that “Since 1998, more than 80 percent of the infants in California who have died from pertussis have been Hispanic.” All 7 California deaths this year were latino infants. “Infants have the highest burden of pertussis disease. Hispanics are overrepresented in pertussis cases, and the reason remains unclear. Immunization coverage did not seem to play a role and no differences in socioeconomic risk factors were found in Hispanic children, including family size and household contacts, with the exception of higher Medicaid coverage. Future studies and immunization policies for the prevention of pertussis should target the elimination of this disparity.” www.txpeds.org/u/documents/castagnini_pertussis1.ppt This does partially explain why CA and TX have high pertussis incidence. Of course infants and young children are more likely to be taken to a physician or hospital for persistent coughing and thus more likely to appear on the radar, while large numbers of adolescents and adults walk around infected without seeking medical assistance. A 2005 paper by UCLA researcher J. Cherry estimates that there are 800,000 to 3.3 million cases of adolescent and adult pertussis in the US per year. PEDIATRICS Vol. 115 No. 5 May 2005, pp. 1422-1427 (doi:10.1542/peds.2004-2648) “Pertussis incidence was 74% higher in Hispanic infants than in infants of other ethnicities throughout the 1990s despite comparable childhood immunization rates.” http://the-medical-dictionary.com/pertussis_article_3.htm

Sorry, Anon, I'm a Marin native and my family still lives there, so I'm very familiar with Marin demographics and Marin culture. Your information is inaccurate. It's the upper-middle-class crowd who are fueling the high numbers of vaccination exemptions. Remember that public schools require vaccination except by specific signed exemption form. Marin City kids are not attending elite private schools, nor are their parents likely to be seeking out the exemption forms to fill out. That's why counties with much higher numbers of low-income students aren't higher on the list. I can't speak for the other counties, but that's why Marin tops the list.

I also lived in Marin for several years. Your general comment about Waldorf schools did not specify Marin. High rates of pertussis in the other CA counties with demographics very different from those of Marin as well as high rates in other states don't support your speculation that Waldorf schools are an important factor in the CA pertussis outbreak, or even specifically in Marin County. You did not back up your Waldorf assertion with any documentation of facts. Do you have any data showing evidence of high confirmed rates of pertussis in Waldorf schools? I am no particular fan of Waldorf, but I dislike the finger pointing based upon speculation. Pertussis epidemiology is a complex matter. FYI, exemption forms do not need to be "sought out", in California, it is the same form that all schools require (public and private) to report immunization status. You also state "That's why counties with much higher numbers of low-income students aren't higher on the list." What about Fresno, Del Norte and Madera counties, all within the top five for pertussis incidence? These are not counties known for wealthy individuals and "elite private schools".