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KPBS And Watchdog Institute Investigation Questions Efficacy Of Whooping Cough Vaccine

Audio

Aired 12/14/10

Why is a disease that was nearly extinct 30 years ago, finding its way back not just in this state, but in other parts of the country as well? A four-month investigation by KPBS and the Watchdog Institute, a nonprofit investigative center based at San Diego State University, has found that many people who have come down with whooping cough have been immunized. We'll hear the details of the investigation.

Whooping cough is making a comeback in California, and sometimes its deadly. Almost every week there are more reports from the San Diego County Public Health Department of confirmed cases. Why are so many people getting sick, in spite of being vaccinated with the latest vaccine?

Guest

Joanne Faryon, she is a KPBS reporter and producer of the documentary premiering this week, "When Immunity Fails: The Whooping Cough Epidemic."

Kevin Crowe is a reporter for the the Watchdog Institute, a nonprofit investigative center based at San Diego State University.

Roxana Popescu is a contributor to the Watchdog Institute, at San Diego State University.

Read Transcript

This is a rush transcript created by a contractor for KPBS to improve accessibility for the deaf and hard-of-hearing. Please refer to the media file as the formal record of this interview. Opinions expressed by guests during interviews reflect the guest’s individual views and do not necessarily represent those of KPBS staff, members or its sponsors.

ALISON ST. JOHN: You're listening to These Days on KPBS. I'm Alison St. John sitting in for Maureen Cavanaugh. Whooping cough is making a come back in California, sometimes it's deadly, almost every week are more reports from the public health department of more confirmed case, why are so many people getting sick in spite of being vaccinated with the latest vaccine. KPBS reporter Joanne Faryon is researching this question, and coming up with some questions that need to be answered, by public health authorities. So you can always join us, the number is. 1-888-895-5727. So Joanne, thanks so much for coming in.

FARYON: Thanks for having me.

ALISON ST. JOHN: Joanne is a KPBS reporter, and she's gonna be airing a special report on the TV called when immunity fails, the whooping cough epidemic, later this week. So Joanne, when you first started looking into whooping cough, I remember sort of thinking, okay, this is just a few cases. What made you decide, that this was worth looking into so closely?

FARYON: Well, there's two parts to that answer. The project that I work in, envision San Diego, we pick a topic every two months that we decide we're gonna really look into this, and dig up whatever we can. And we want to find issues that are important the community. And I remember in one planning meeting, Kenny Goldberg, our health reporter, earlier in the we think, had said, you know, there have been some whooping cough cases in the county more than normal. So whooping cough came up in one of these manning commits, and it was, you know, is this something different this year that's causing this to happen? That was sort of the bigger questions. We decided let's spend a little bit of time looking into this, and actually what I noticed and what other reporters in the news room noticed when I was speaking to them is that the people who were tested positive were immunized. Because in San Diego County, the news release that went out every week, they would actually list on the bottom of it what the immunization status was of the people who tested positive. What they weren't doing was adding it up. So that was the first thing we decided to do. Okay, news release after news release, wait a minute, there seems to be a pattern. So we asked them for the data and we added it up. And that's when we found this surprising kind of trend, that more than half, in fact, two out of three people who got whooping cough had been immunized. From there, what's when we went to the Watch Dog Institute and said, okay, we have San Diego County data, let's find out if this is happening in this state but other states as well.

ALISON ST. JOHN: So according to those press releases, what was the immunization date?

FARYON: Well, in San Diego County, it was about 68 percent of the people who were tested positive for whooping cough, actually were up-to-date with their immunization. So then we wept to other counties in the state and fund a very similar 2010ed. The other thing that we found was other counties department have the data. They weren't keeping track of this. We even went to other states because California is not the only state right now that's experiencing outbreaks like this. And we went to other states and found the trend held as well.

ALISON ST. JOHN: So to some degree, the county of San Diego is to be commended for having the figures at hand.

FARYON: Oh, absolutely. But they were keeping track -- they probably -- in terms of the research that we looked at, they had very solid data. Therapy forms that they had to fill out. Whooping cough is a reportable disease. That means health officials have to report when there's a positive case, the county has to report it to the state, and the state has to report it to the CDC. There's a form that everyone in the state is supposed to fill out. San Diego County is filling out that form, they're filing it on time, they have up to date statistics. We found many counties did not have up-to-date statistics.

ALISON ST. JOHN: So in order to put a face on this story, you found a family. Tell us with this family.

FARYON: Well, like we always do, we reach out to our audience, and we ask them to help us tell this story. So we did that. We ran radio spots on the air and said, look, if you're experiencing -- if someone 234 your family was tested positive, we want to hear from you. I have to tell you this story, Alison, the family that contacted us, they're a young family, they have three sons, a three-year-old and a four-year-old, and they just had a newborn baby. His name is Matthew. Matthew is two weeks old, and he got a cold, and they knew that that was an early age to get a cold, because, you know, they're new parents. So they called the doctor, and the doctor said, you better bring him in, and because the parents had heard so much about whooping cough on the news, and because the doctor was so aware of it, she said let's test him just in case, and let's put him on an antibiotic. Because whooping cough, it's caused by a bacteria, if you catch it in time, and you get an antibiotic, you can really stop the progression of the disease. The problem is, usually it's not diagnosed in time. So the baby was started on an antibiotic. Six days later, the parents got a call from the State of California Health Department, and it was a positive whooping cough diagnosis. The day after -- the day of that phone call, the parents were in their car, driving with all of their sons, their newborn baby, to the pediatrician, in a panic over, you know, how can this be happening? Because all of them were immunized. Even the parents got their boosters. And they heard us asking, has whooping cough affected you? Contact us. So the dad did that night. He sent an e-mail and said, you know, I can't believe this is happening to our son. And I want to know why too. So we met women him later in the week, and the documentary, we follow their story. We follow Matthew's progression of the disease. He had a couple of setbacks, and in the documentary, you learn what happens.

ALISON ST. JOHN: Okay, now, why is it that whooping cough is so deadly for infants?

FARYON: Well, with adults, whooping cough is like a bad cold. And actually, sometimes it gets misdiagnosed as bronchitis. The problem is that the bacteria infects your upper respiratory system, and it does damage to that -- to your lungs, to sort of that whole respiratory tract. With young, young baby, they can't cough up the secretions that collect in their respiratory tract. So actually in newborns, you often don't hear a cough. They don't have whooping sound, which is why often it gets diagnosed too late. With older children, with adults, we cough it up, and often the cough can last six weeks, 8 weeks, and we might feel really horrible, but we get through it. Babies can't do that.

ALISON ST. JOHN: And isn't that easy to diagnose? In this case your family was savvy enough to say, we need to look into this. But even if you do, is it hard to diagnose.

FARYON: Well, there's a test that is done, it's called PCR, and it tells you within days whether it's positive or negative. And the problem is, with whooping cough, you don't often have a fever. In newborns too -- it was a stuffy nose that really with baby Matthew that was the first indication. But it wasn't just a stuffy nose. He seemed to have trouble breathing. And again it's just parents who are really in tune. There's been so much public awareness right now that doctors and families know that this is a possibility. This is a disease that 30 years ago, when we were growing up, this was practically wiped out. Very few people got whooping cough. We looked 59 the historical data as well, and we found that in the 1970s, the rate of disease was less than one per 100000. I believe there was one year where less than a thousand people in the country got whooping cough.

ALISON ST. JOHN: And how did that achieve that?

FARYON: With mass immunizations. In the early 1900s, a team of scientists in Belgium actually isolated the bacteria that causes whooping cough. It's Bordetella pertussis. After that discover, scientists were able to start working on a vaccine. By the late 1940s in the United States, a new vaccine was introduced. It was called a whole cell vaccine. By the late 1940s, early 1950s, kids across the country were being immunized. By the '70s, this was a disease nearly gone. Less than one per 100000. What our research shows, and one of the reasons we've been asking so many questions, is in the late '80s, mid90s, you start to see the rates creep up. We now have rates in California, in some counties, such like San Luis Obispo, their rate of disease is almost [CHECK] less than one per one helped thousand about 25 years ago, it's now 18 per 100000. That's nearly a 20 fold increase. So the statistics told us, we should be asking these questions. Why has whooping cough returned?

ALISON ST. JOHN: Well, do you get the feeling that they put a lot more resources into their vaccine and into eradicating it back in the 40s at that time?

FARYON: Well, no. I think the defense is, a couple of things happened. So we had mass vaccinization. People were getting immunized. People are still getting immunized. Our rate over all of immunization is 85 percent, and in terms of kids who enter kindergarten, less than three percent, I think it's 2.3 percent of children opt out of immunization for personal reasons. So the vast majority of children in our system are immunized. But a couple of other things happened. In the 1980s, there was a lot of controversy surrounding the whooping cough vaccine. It was the whole cell vaccine. And it was associated with some fairly serious side effects. Prolonged crying in infants, seizures. And in fact some science did indicate if children were prone to epilepsy, it perhaps brought on seizures earlier than had they not been immunized. This was the old vaccine. So there was a lot of pressure on government, there was actually a documentary that was produced called vaccine roulette. And it really caused a huge stir in the country. It forced the government into funding some new studies and saying, okay, maybe we ought to come up with a new vaccine. So in the 1986, the FDA licensed a new whooping cough vaccine associated with far fewer side effects. It's acellular. And that is the one that we use today in the U.S. there are two vaccines, they're acellular, and they're deemed safe in terms of the scientific literature. Another thing happened in the late 90s that they were changing vaccines, scientists in the Netherlands noticed that the bacteria that causes whooping cough was also changing, that there was a new train developing. So we had these two things happening at the same time, and the third thing that was happening was, oh, our rate of disease is decreasing. So whether they're related, we don't know, [CHECK].

ALISON ST. JOHN: Okay, so there's some different opinions about what's actually going on here, and coming up after the break, we'll find out what made you decides to go to the Netherlands and follow up on all of this. We're speaking with Joanne Faryon, KPBS reporter about a documentary she's producing this week called when Immunity Fails, the Whooping Cough Epidemic. And we'd love to hear from you, so if you have any questions or comments, the number here is 1-888-895-5727. We'll be right back.

And you're back on These Days, we're talking about the whooping cough epidemic and some research that's been done by KPBS reporter, Joanne Faryon. And we're bringing in a new guest this hour, Kevin Crowe, who is with the Watch Dog Institute, a nonprofit investigative center based in San Diego State University. Good morning, Kevin. Thanks for coming in.

KEVIN CROWE: Good morning, Alison.

ALISON ST. JOHN: Now, you sort of added to Joanne's research by going around the state and asking questions. Tell us a bit about what your approach was to this whole questions of what is going on with the increasing number of cases of whooping cough.

KEVIN CROWE: Well, it all started by -- with getting some data from San Diego County, health and human services, and they had kept really good track of of the pertussis cases that had been diagnosed in San Diego County. So they kept track of all the things like age, sex, when they were up to diagnose date, all those good things. And Joanne had reported a story -- what was it? Back in September or August?

FARYON: Yeah, late August.

KEVIN CROWE: Okay. She had reported a story that almost two out of three people who had been diagnosed with whooping cough in San Diego County had been up-to-date with their immunizations.

ALISON ST. JOHN: Right.

KEVIN CROWE: And we wanted to see if that trend held state wide. So we figured out that San Diego reports all these statistics to the state, and they report the raw data to the department of public health, [CHECK] it was lacking in a lot of information. And so the immunization history was unknown for between 65 and 70 percent of the cases that had been reported so far. So we asked them why, why their information would be so different from San Diego County's, and they said, well, if you want more accurate, up-to-date information, go to the county department of public health themselves. And so we started to do that. And we requested information from 19 local health jurisdictions around the state but only received really detailed information from about nine.

ALISON ST. JOHN: Was this because the state actually doesn't collect it or that they collect it but it was old information?

KEVIN CROWE: Well, they do collect it, but you know, they collect it on a rolling basis. It's an ongoing epidemic. Of and so there are these things called pertussis case report forms that everybody, that the local health [CHECK] are supposed to fill out when it's a new diagnosed case. And it's very detailed. There's a lot of information on it, and sometimes the information the local health jurisdiction gets doesn't complete the form. So they may take extra time to do it. So there are just these periods of lag. There's a willing time in between how the cases are reported.

ALISON ST. JOHN: Does it strike you interesting that the state doesn't keep an up-to-date report on something that has already been termed as an epidemic?

KEVIN CROWE: Well, it seems that they're starting to catch up now in the terms of the number of cases, but because the epidemic has slowed a little bit. One of the things they said was, you know, it's -- some of the counties were perhaps lagging behind in their reporting too. Rather, the local health jurisdiction said in turn, well, we're under staffed, we don't have a lot of money, the epidemic's hitting us really hard, we're having to deal with these things on a day to day basis.

ALISON ST. JOHN: Kind of get the figures.

KEVIN CROWE: Right.

ALISON ST. JOHN: So what did you find then? How many did you say you got a response form?

KEVIN CROWE: We got detailed responses from nine local health jurisdictions.

ALISON ST. JOHN: What did you find?

KEVIN CROWE: Well, we found that between -- for cases in which immunization history is known, between 44 and 80 percent of the people who had been diagnosed with whooping cough had been immunized.

ALISON ST. JOHN: So what does that lead you to -- what sort of questions does that lead you to ask?

KEVIN CROWE: Well, it it leads you to ask a lot of questions. I think -- people were -- some local health officials were initially surprised to hear those kinds of figures. But doctor mark Horton who's the direct offer of proof the department of passport health said, really, it's a matter of arithmetic, if a vaccine is only 80 to 85 percent effective, and you have a lot of people who are effective, a lot of those people are gonna have been vaccinated because it doesn't work for everybody. And a lot of those cases are immunization failures, but that's where the question really arises of how effective the vaccine really is. And [CHECK].

ALISON ST. JOHN: We have some callers, let's start talking to them, by the way, the number here is 1-888-895-5727. And John is calling from Del Mar. Thanks for calling, John. Go ahead.

NEW SPEAKER: Yeah, I was wondering, perhaps it's difficult to tell if there has been underreporting of the cases. I for one have two colleagues how have what appear to be classic whooping cough symptoms, protracted coughs for months and gagging. And they got the culture, but after they had been treated with antibiotics, and they never did any additional diagnostic tests. So my sense is that there's probably under reporting of the number of indicates in San Diego.

FARYON: We actually have science to back that up, yes, absolutely. I think the estimates are whooping cough in adults only about ten in 15, maybe 20 percent of the cases are actually diagnosed, not actually reported but diagnosed. So the vast majority of adult case are never dying in the cased. They said something interesting about your colleagues are treated with antibiotics and they did a culture. I did [CHECK] PCR is the method that's used right now, it's a positive or negative test. Labs use to do bacterial cultures. If you've been treated with the antibiotic, you're right, you might end up with a false negative, especially if you've been treated with a bacterial culture, [CHECK] and it's the diagonal that is creating that cough. So you can sort of be -- I want to put in quotation marks, kind of cured of your whooping cough, the bacteria goes away, but you're still sick months later. [CHECK] the diagnostic testing, switching over to PCR. The other thing that Kevin and I discovered is that out of the 7000 positive whooping cough cases, I believe the C, did C, how many actual cultures did they have, Kevin? Was 20 --

KEVIN CROWE: 24.

FARYON: 24. So the cultural information is what the CDC can use to determine what do we have on our hands? You know, is the strain changing? What strain are we dealing with? They only have 24. And that's primarily because the method of the diagnostic testing has changed. PCR, they're not doing the cultures anymore in state labs. They're doing this other test, and with this other test, you don't get that culture information.

ALISON ST. JOHN: Anything you want to add to that Kevin?

KEVIN CROWE: Well, no. I think one of the reasons they switched to PCR testing was that it's faster and it's become very accurate. I don't know if it's less expensive than bacterial cultures, but it's an easier test to facilitate I think.

ALISON ST. JOHN: So costs came into the equation here. Yeah.

KEVIN CROWE: Perhaps.

ALISON ST. JOHN: So this could actually be a very under reported epidemic in fact.

FARYON: Oh, it is. I mean, doctor James cherry who's one of the leading experts in the U.S., he's a researcher at UCLA, he's a pediatrician as well. That's one of the first things he told us. That if you go looking for pertussis, you will find pertussis, that it is -- he believes about 15 percent of adult cases are actually reports and diagnosed.

ALISON ST. JOHN: Whoa.

FARYON: That it's a very under reported disease.

ALISON ST. JOHN: And there's really nothing more you can do after taking the antibiotics to make yourself feel better?

FARYON: As far as I know, no. And in adults, it's -- the danger is that you're going to be spreading the disease.

ALISON ST. JOHN: Right.

FARYON: It's most serious in terms of being deadly. It's deadly in infants. In adults and older children, really it's -- it's first of all, for a couple of months, you're really sick and also that you can spread this disease. And that's really the big danger when it affects older people.

ALISON ST. JOHN: So let's take a call on that note from Brad in San Diego, who has a question. Brad, go ahead.

NEW SPEAKER: Hi, thanks for having me on. The story of baby Matthew really hits home for me. Because my wife and I are expecting our third child here in January, and we've all made sure that we were vaccinated. And my understanding is that infants are unable to be vaccinated until they're approximately three months old. So my question is, did anyone in Matthew's family who has actually been vaccinated contract the disease?

ALISON ST. JOHN: Thanks Brad.

FARYON: Great question. So you're right. [CHECK], three doses before they're considered really up-to-date as babies. Baby Matthew's family, yeah, they were all immunized because their doctor again said, hey, there's this whooping cough epidemic, you're expecting a baby, so the dad got his booster shot a month before the baby was born. [CHECK] after delivering the baby. So the first question that the state -- that the pediatrician asked, once Matthew was diagnosed positive, was okay, who in the family has it? And she said, well, no one, we've all been immunized. The dad, because he was so upset about this, he actually got tested for pertussis, and one of his sons were tested because he had a cold. And they thought maybe it was us. They both came up negative. That baby, how much it was exposed to the baby -- I believe they said they took the baby at once to the grocery store.

KEVIN CROWE: Not often, yeah.

FARYON: Not often. I think once. Soap it's a very, very contagious illness. But the cocooning is sort of what this process is called, in terms of family members around a baby or a newborn baby getting immunized, that's called cocooning. And in our research, no matter who we interviewed, they said it was till the best strategy in terms of trying to protect infants. If everybody around that infant gets immunized, then that's still the best protection that you can offer your newborn.

ALISON ST. JOHN: So, I mean, you can understand Brad's concern, just about to have another baby. And that's pretty much the advice is that's the best you can do?

FARYON: And I'll tell you what the dad's advice is too to everyone. He said, you know, we thought we were being under protective when we brought Matthew to the doctor. But we're glad we were just concerned. And I have to say though, I also interviewed the pediatrician, and she wanted to say, look, we don't want to panic people either. And not every cold and not every case of the snivels is necessarily whooping cough. Doctor Dean Seidlinger, [CHECK] he said the same thing, I said what is your toughest job during this epidemic? And he said I don't want to cause panic. I want to cause concern but not panic. It's yes, you should be aware of this, yes, you should be look for things like this. But don't worry, it's not necessarily every baby who has a stuffy nodes, they don't necessarily have whooping cough.

ALISON ST. JOHN: So Kevin, let's just go back to your research around the state, and speaking of panic, was there any sense from any of the counties that this was some panic going on? I mean, they're saying they don't have the resources to keep the figures. They're really dealing with the epidemic the best way they can. What kind of information did you get?

KEVIN CROWE: I think by the time that we started to request information from them, that the epidemic started to slow a little bit. It peeks spring, summer time. It started to slow, but it hadn't totally slowed down. It hadn't slowed as much as they were expecting.

ALISON ST. JOHN: And we're getting back into the winter months now.

KEVIN CROWE: Right, right, right. And so there was some panic, and there was a little bit of, hey, we're under staffed and we're offer worked. And I don't know if it was just because we were requesting information and it was one more thing we had to deal with. Of but there was in a couple of counties, I think, there was a little bit of concern about how quickly they were getting the information to the state. But on the state's end, they say in order to respond to epidemics like this, they don't need information on every single person in order to respond. They say that they can respond adequately with the information they have.

ALISON ST. JOHN: And would you say that the findings that you made pretty much supported what Joanne found here in San Diego in terms of the effectives of the vaccine?

KEVIN CROWE: Well, we can't draw direct correlation to effectiveness.

ALISON ST. JOHN: Okay.

KEVIN CROWE: Of the vaccine. I think it raises questions when so many people who have been immunized are diagnosed with whooping cough. But that's a hard line to draw because it's not a hundred percent effective.

ALISON ST. JOHN: Uh-huh. Nobody's claiming it is.

KEVIN CROWE: Right, if somebody had claimed it was a helped percent effective, maybe we would be able to say something. But I think the leading scientists and the experts that we've talked to have said, well, there's a chance that the strain is changed and maybe it's taking advantage of a window of waning immunity that perhaps wasn't available before.

ALISON ST. JOHN: So Joanne, is there, like, you know, two sides of what the scientists are saying in terms of how effective the vaccine now is 123450 right, so, to pick up too on what Kevin was saying, I think what the immunization data told under the circumstances, it give us enough to ask a question. It didn't tell us whether the vaccine was working, and it department tell us necessarily whether it was effective or not effective, it gave us enough information to ask the question, is it working, because like Kevin was saying, loon epidemiologist will tell you, you will always find immunized people getting sick. [CHECK] so our question was, were we finding that 15 percent, or theoretical 15 percent that it doesn't work on? So the data just gave us an opportunity to ask more questions. So what we did -- two other things. I mentioned before that we looked at historical data and rate of disease, that was climbing as well. So it wasn't just vaccine failures. We knew rate of disease was increasing. Now, the third thing, which is sort of what brought me to the Netherlands, we were looking at, what does the science say? What does the research say? Well, in the 1996 the Netherlands went through a similar epidemic. It caught the whole country off guard. This is a small country where they have a high immunization rate, and suddenly they have an epidemic in 1996. The Netherlands has an equivalent of the CDC, and it's the center for infectious disease control, and there's a scientist there, Doctor Fritz Mooi, and he's in charge of whooping cough surveillance. He's published papers over the last several years on a changing strain of whooping cough. He calls it the PTX3. And what he has found is the bacteria which causes whooping cough has changed slightly. And this change causes it to make more of this pertussis toxin. The toxin according to his theory is the thing that makes you sick when you get whooping cough. So his theory is, if it's producing more toxin, that means it can make us sicker.

ALISON ST. JOHN: Uh-huh.

FARYON: And it can cause more vaccine failures, and also Kevin mentioned this period of waning immunity. Everyone agrees that whether or not you're immunized against whooping cough or whether you get it naturally, your immunity does not last a lifetime. How long it lasts is really the other question.

ALISON ST. JOHN: Uh-huh.

FARYON: Is it five years? Is it ten years? So doctor Mooi's theory is, [CHECK] it might happen a little bit sooner with this new strain. All researchers we spoke with agree there is a new strain of whooping cough. [CHECK] whether it's more virulent as Mr. Mooi asserts, that's where they disagree. So I went to the Netherlands after months of e-mail exchanges with doctor Mooi to ask him about this theory, to ask him, you know, can it be creating more vaccine failures? Can it be making people sicker? And really, why is it that we're not hearing more about this.

ALISON ST. JOHN: And is more being done in the Netherlands.

FARYON: That's right.

ALISON ST. JOHN: And did you get the impression that there is a different attitude? A different take on this whole thing in the Netherlands.

FARYON: Well, in the Netherlands, they believe, and their research says that we believe that highly immunized communities are going 32 these epidemics in part because of this more virulent strain. And he also did studies showing that in the Netherlands, there were increased hospitalizations, and an increased rate of fatalities that coincided with this new strain started making its way through the Netherlands. [CHECK] he asserts that it's not a popular theory because if what he says is true, it would mean we would need new vaccines, that perhaps the current vaccines report as effective against this new strain. So he believes that his research is not -- or his theory is not a popular one.

ALISON ST. JOHN: And we'll be talking a bit about that whole question about, so, how come we don't have more research going into a new vaccine in the next segment. But we had a call from Charley. Is Charley from Sorrento Valley, thanks very much for waiting. Go ahead and ask your question.

NEW SPEAKER: Yeah, I just have a question about the -- just the statistics of immunization on the general public. You upon, to understand the infection rate or the -- the whooping cough cases and you're saying that two thirds of them have been immunized, what about thought the public public? What percentage of the general public has been immunized for whooping cough.

FARYON: So, these are the stats that we were -- and maybe Kevin, you have additional numbers, but in San Diego County, 85 percent of children 18 and younger are immunized. Not just necessarily against pertussis, but it's an overall immunization rate. I know that the Watch Dog Institute also looked at some other statistics in terms of when your child enters kindergarten, the parents have the [CHECK] and they can decide that they don't want to have their child immunized. In San Diego County, I believe for kids entering kindergarten, that exemption rate is 2.3 percent, less than three percent of kids opting out. So in terms of immunization entering kindergarten, the vast majority of kids are immunized. I know there have been a number of media reports that link high rate of disease in California counties with the high rate of personal exemption belief. In other words, in county that had high rates of disease were these kids where parents weren't immunizing their kids. Of ask Kevin, that's something that we looked at, and half the counties were, and half the counties weren't. There didn't seem to be a direct link.

KEVIN CROWE: Right, there didn't seem to be a direct [CHECK] there are a lot of unknowns of it's hard to, you know, figure out how many adults have been immunized. You know, children are in a system, and so it's easier to keep track of them.

ALISON ST. JOHN: Uh-huh.

KEVIN CROWE: They're supposed to be immunized if they're at school.

ALISON ST. JOHN: Right.

KEVIN CROWE: If not, they can do a personal belief exemption, which requires the permission of a parent or a guardian. So again, that's easier to keep track up. But there was not a direct correlation between a higher than average personal belief exemption rate and whooping cough.

ALISON ST. JOHN: And it you understand sos like there's just a lot of adults out there who had not been immunized at all, who are not in the figures and we don't have a clue where they fit into this whole equation. You know?

KEVIN CROWE: Right.

ALISON ST. JOHN: We are gonna take a break, but we're talking with Joanne Faryon, KPBS reporter and producer, and Kevin Crowe, who is a reporter with the WatchDog institute at SDSU. We'll be speaking with another guest in the coming segment, and we'd like to hear from you so stay with us.

You're listening to These Days on KPBS, and we have in studio Joanne Faryon KPBS reporter, Kevin Crowe, reporter of the Watch Dog Institute at SDSU, and now joining us is Roxana Popescu, who is a contributing reporter to the WatchDog Insitute, and we're talking about this whooping cough epidemic and the possible waning immunity of the vaccine. So Roxana, thanks so much for joining us.

POPESCU: Thank you.

ALISON ST. JOHN: So now your element of this whole investigative report was really looking at the question I think is in a lot of our minds, well, what's being done about this? If there is an epidemic, who's looking into this?

POPESCU: Sure, so there's a team of -- well, a lot of people are looking into it, researchers and universities, the vaccine companies, policy makers. And my research focused on a group of experts. The group is called the global pertussis initiative. And these are 35 experts from around the world, extremely distinguished, affiliated with universities, with also some of the vaccine companies. And they're getting together periodically and looking at this epidemic and trying to understand the disease, and understand different ways of -- you know, how it could be controlled better.

ALISON ST. JOHN: So tell us a bit about who are members of this group.

POPESCU: Sure, so there are members of about -- the members come from around the world, from 16 countries issue a lot of them are based here in the U.S.. And they're, you know, affiliated request universities, they're distinguished professors, researchers of whooping cough, and they get together once in a while and try to compare what's happening in their countries and in their regions and come up with the global strategies.

ALISON ST. JOHN: So Joanne was just talking about how, you know, in the Netherlands there appears to be some research into this bacterium to see whether in fact it's mutating. And perhaps the Netherlands might be taking it maybe more seriously than the United States? I mean, what did you find about this group's attitude to the research?

POPESCU: Well, what was interesting is this group is not addressing publicly [CHECK] the idea that the vaccine might not be effective or might not be -- or that the strain might have mutated, or that there might be a new strain. And we were wondering, why [CHECK] perhaps is not popular or perhaps it's a risky position but it's still an interesting view, it should definitely be considered by the scientific community. And so we were curious, you know, why isn't this view being taken more seriously? And what we found in our research is that this group, the global pertussis initiative has a lot of ties with one of the vaccine makers,ing and some ties with the second vaccine maker. So one of them is Sanofi Pasteur, and the other is Glaxo Smith Klein, and these two companies make all of the vaccines in the United States. And Sanofi is funding these experts to get together once in a while and come up with recommendations. So it's just raised some questions about ethics, about scientific objectivity [CHECK].

ALISON ST. JOHN: What about the argument that a group like this should have the pharmecuetical companies as a part of it? They're the key players and often the ones that have the most money, so I guess that would be one of the arguments for including them.

POPESCU: Absolutely. They should be included. And will when I spoke with the group's chairman, and one of the initial members of group, doctor Stanley Plotkin, he's professor of -- I believe it's pediatrics at the University of Pennsylvania, and he was very up front about it. He said, yes, we're taking money from the vaccine company, but who else is gonna pay for this? So they're between a rock and a hard place. They want to work on this disease. They're not these corrupt ethically dirty individuals. They really want to help and make things better. But it raises some questions because if they're accepting money as a group and both on an individual bases, [CHECK] are they saying what they believe is right, are they saying what they think the vaccine company would want to hear and can we really ever know that once that money is trading hands? Once that influence is trading hands?

ALISON ST. JOHN: And what would the vaccine companies actually want to hear?

POPESCU: Well, if they're producing a vaccine that's now, I think a $2 billion market in whooping cough, [CHECK] then they probably want to believe that all the retch that they've done, it paid off.

ALISON ST. JOHN: Is there any sign that there's a motivation for new research? I mean, couldn't they make profit off a new vaccine if they developed one?

POPESCU: Right. Well, one -- absolutely, that's a possibility. The question is, if they make a new vaccine, how long will it take to get approved, [CHECK] how far more money will they have to invest in the FDA research, it's lengthy, it's costly. And then make make there's some issues with it, there's some side effect. So they could take so much effort, so much money to -- let's just steak with what we, this one is working well enough, it's 70 percent effective, 80 percent effective, although our research is showing that perhaps it's not even that effective. But it's quite effective. So why rock the boat? Let's just stick with what we have.

ALISON ST. JOHN: Well, Joanne, how effective are public health officials actually saying it is.

FARYON: Well, the initial response from the CDC, they sent us a study saying that the vaccine is more than 90 percent effective. [CHECK] 1998 and 2001, and they said in this age group, the vaccine is more than 90 percent. It was -- it could not make -- draw conclusions in terms of how long is it effective, and it also did not look at strain information. That's the big question. So in terms of these efficacy studies, when they were done, they tested the current vaccine on the old strain. So how effective is this vaccine on the new strain? That's really the big question. That's the question that scientists have been asking. And actually, it's a question that now it looks as though health officials here are willing to ask. During the course of our investigation, we learned that health officials from the CDC, from the state health department, they're going to team up with two UCLA scientists and they're gonna look at this. They're going to test this theory. They're going to look at whether or not the new strain of disease is in fact more virulent, and if it's more virulent, did that contribute to the deaths of several babies in California, is it making people sicker? And I got an e-mail from health officials from the state just the other day talking about this study, looking at this period of waning immunity. So I think at the end of the day, I think absolutely our audience should be asking questions just because there are vaccine failures does not mean the vaccine does not working and we want to state that. All it meant is let's ask this question. And with vaccines, what we learned is this is a really controversial issue. [CHECK] and we're not. That's not what this is about. This is about an epidemic, and this is about an increasing rate of disease over a period of time over the past two decades, disease that was virtually gone. And it's back, and it's asking why? . And unless we start looking at data and forcing health officials to look at data and keep track, who's gonna ask this request? Who's gonna ask why is this happen something so that's really -- the the end of the day when you add up what we've been doing, and what we've been doing together, it's really trying to get the debate happening, getting people engaged and asking these questions.

ALISON ST. JOHN: Is there a time line on when it -- is it a white paper that they're producing on the epidemic?

FARYON: Kevin has the white paper.

KEVIN CROWE: Well, I think doctor Jeffrey Miller's lab at UCLA, along with doctor James cherry, they've already started looking at these strains. And I think he initially started the study. They're looking for funding right now to continue.

ALISON ST. JOHN: They're looking for funding to continue. Okay.

KEVIN CROWE: Right. That's another funny side. That's not something that we covered in articles and in the reporting, really, but that was something that a lot of scientists point to, and it kind of goes to some of Roxana's reporting, there's not as much money, they say, coming out of the national institute for health, coming out of these studies. So maybe increasingly they're having to rely on the vaccine companies to fill the void a little bit.

ALISON ST. JOHN: Roxana?

POPESCU: And I think one thing that we're -- we're not suggesting that, you know, these researchers should stop taking money from these vaccine companies. I think what we would hope for is it I think what the public has a right to ask for is more transparency about the ties. That's the main thing. Because these pharmaceutical companies have tremendous research budgets, and their goal is to create new vaccines. So I believe it would not make a lot of sense to say money needs to stop going into that research. [CHECK] policy makers, when they're making these decisions, they need to look, what are the numbers saying? Are people getting sicker? Are the vaccines working? What's the efficacy? What strains were considered? And really ask those hard questions. And if that's happening, then where the money is coming form is really not that important.

ALISON ST. JOHN: And if in fact there is quite a bit of money behind the pharmaceutical companies in this case, is there anything to stop that source of money from funding this white paper?

KEVIN CROWE: I don't think we know at this point.

POPESCU:

FARYON: No, and I think these researchers were gonna go after government funds to try and fund this. I think this UCLA, they're putting the up front costs and they're hoping that it get funded by a government agency.

KEVIN CROWE: Right. [CHECK].

POPESCU: And one move would be perhaps to spread the risk in a way, the ethical risk and have people fund it. So that way you have more funds at your disposal, you have fewer interested parties, with a big stake in the results.

ALISON ST. JOHN: Good point. And of course it's not the State of California only that is concerned about this. Of I mean, this epidemic isn't just happening in California.

KEVIN CROWE: Right, yeah. We looked at some of the data coming out of the CDC to the extent that we could. Of and I contacted health officials in Texas and Minnesota and Ohio and Michigan. Of and officials in the first three states got back to me and in Texas and Ohio, it was -- their -- the people who had been diagnosed with pertussis between 67 and 75 percent had been immunized.

ALISON ST. JOHN: Uh-huh.

KEVIN CROWE: And in Minnesota, they didn't provide the raw data that we requested. But they broke it down by age groups, and in their ranges, it was 40 to 75 percent.

FARYON: Interesting anecdote too, Kevin was making all of these calls, and another researcher, Sandy --

KEVIN CROWE: Sandy Coronilla.

FARYON: Yeah, was also contacting them, and she was later finding out towards the end of our investigation that suddenly the CDC was showing up in some of these places that we had already contacted weeks or months ago. So they were kind of hot on our trail. And it was first of all interesting to note, that okay, now they're looking at this and prompted by some questions and were being asked.

ALISON ST. JOHN: Yeah, well, I think news reports have had an effect. We have a caller on the line, John from Hillcrest who has that point to make. John, thanks for calling of go ahead.

NEW SPEAKER: Yes, I am. [CHECK] I'm so glad you guys are doing what you're doing. Because very early on in the year, I came down with this awful cough, didn't know what it was, happened to be at the doctor's office, they order had it, said, that's horrible. Three days later, my aunt, my uncle was a doctor, she came to me and said, that sounds like whooping cough to me. You know, I heard whooping cough when I was a kid, I'm in my late 50s and eventually they did tests, they never got the results back from the test. Two and a half months I suffered from it, where I was, like, the classic symptoms. You couldn't get anymore classic simples than what I had. And yes, it was maybe six weeks into it before anybody said pertussis. And the income thing I knew it was all over -- it was in the news in San Francisco, it was everywhere. There was even bulletins up at the doctor's office, get your children immunized. But no matter how many times I said it to them, I said what happened to the results? Nothing ever came about it. But one question I had, if you've had it, which I've had, and every so often you can found yourself still coughing if you're, like, laughing or something, it's just very strange. And it takes your breath away again. How long does it last, and what's the period where you can spread it?

ALISON ST. JOHN: Joanne, do you have an answer for that.

FARYON: Well, what I have read, and I'll ask Kevin and Roxana if they came about the same statistics. But about two months ago, it can last about two months of it's funny when you said taking your breath away, because that is, like you describe, a classic symptom in the literature. You request get it again. That's another thing. Just because you had it doesn't mean you'll never get it again of it's just hike being immunized. When you can get it again, how long you're immune again, that's the big question. Can you spread it? So now, this is really where I don't want to give you incorrect information. I know that while the bacteria, while you're harboring the bacteria, absolutely you're contagious. Which is why, let's say you have somebody in the family who has a positive diagnosis, as in the case of baby Matthew, everyone in the family was put on an antibiotic, whether they tested positive. [CHECK] So they were all treated antibiotics, whether or not, how long you're contagious, I don't know.

ALISON ST. JOHN: Okay. So I think that's a good place. We have to end, unfortunately, there are a lot of questions and you have raised some really valid and important questions that I think the public is now really thinking about a lot. There's a lot more we could have talked about, but for those of you who are interested in finding out more, Joanne, when is the documentary.

FARYON: Thursday night at 9:30 PM on KPBS television. Also you can go to our website, KPBS.org/whooping cough. And Kevin, your website?

KEVIN CROWE: You can go to www.watchdoginstitute.org.

ALISON ST. JOHN: And I'd like to thank you all so much for being here. Kevin Crow and Roxana Popescu of the Watchdog Institute, and Joanne Faryon, KPBS reporter. Stay with us.

FARYON: Thank you.

ALISON ST. JOHN: For the next hour of These Days coming up on KPBS.

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