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No, immigrants are not behind pertussis resurgence

Reported Cases* of Pertussis, Minnesota, 1914 to 2013
*Includes confirmed and probable cases of pertussis/Minnesota Department of Health
Reported Cases* of Pertussis, Minnesota, 1914 to 2013

Two weeks back, the Milwaukee Journal Sentinel ran an article that explored the reasons why pertussis — or whooping cough, as it is more commonly known — has resurged in the United States in recent years.

Here in Minnesota, for example, 4,639 confirmed, probable and suspected cases of pertussis were reported in 2012 — the highest number in 75 years. In 2014, the Minnesota Department of Health documented a smaller but still troubling 1,120 cases, and more than 100 have already been identified this year.

As reporters John Fauber and Mark Johnson point out, experts have identified “a complex confluence of factors” that may have led to whooping cough’s comeback: “a safer but weakened vaccine; more surveillance, especially in adults; genetic changes to the bacterium; and a proliferation of wary parents and anti-vaccine websites.”

“And then there is the disease itself, with its remarkable capacity to spread,” they write. “Each case of Ebola is estimated to generate 1.5 to 2 more cases; each smallpox case, 6 to 7 more. A single case of whooping cough, however, generates anywhere from 12 to 17 more. And every three to five years, there is a major outbreak and the numbers spike.”

Misinformed blame

Nowhere do Fauber and Johnson cite any experts telling them that the resurgence of whooping cough in the U.S. can be blamed on unvaccinated immigrants coming over the Mexican border. And for a good reason. There’s no evidence to support that assertion.

Yet, when the Journal Sentinel article was reprinted last week on the popular conservative website the Drudge Report, Fauber and Johnson suddenly found themselves deluged with emails and phone calls claiming that they had deliberately chosen to ignore the “real” cause of whooping cough’s return.

“Reviewing your list of reasons for its reappearance, I couldn’t help but notice that you sold your soul to avoid the wrath of La Raza by not mentioning the flood of unvaccinated illegals crossing the Mexican border,” one Florida reader told the reporters. “Good work, the Hispanic Racists know they have you terrified to tell the truth.”

The facts about rates

So, last Sunday, Fauber and Johnson published a follow-up piece in the Journal Sentinel. Using World Health Organization data, they point out that “vaccination rates in Mexico and Central American countries are comparable and in some cases superior to those in the United States.”

Here, for example, are the WHO rates, as reported by Fauber and Johnson, on whooping cough immunizations for the years 2010, 2011, 2012 and 2013:

Mexico: 95%, 97%, 99% and 83%

Guatemala: 94%, 88%, 96% and 92%

El Salvador: 89%, 89%, 92% and 92%

Nicaragua: 98%, 98%, 98% and 98% 

And here are the rates for the U.S. during those same years: 95%, 95%, 96% and 94%.

A reversal of border shuttings?

“Based on the numbers alone,” write Fauber and Johnson, “America’s neighbors to the south might consider shutting their borders to residents from Colorado, where just 81% of kindergarten children were vaccinated against whooping cough and 82% were vaccinated against measles, according to a CDC report in October.”

“Also, vaccination rates have varied substantially in pockets of California, where the most recent measles outbreak occurred and where they have been recent whooping cough outbreaks,” they add. “A paper found undervaccination rates ranging from 18% to 23% in five geographic clusters.”

“I do not believe undocumented immigrants are a significant contributor to the increase in pertussis rates,” a public health official in New Mexico told the reporters. “In New Mexico, a much bigger contributor would be the children with school vaccination exemptions.”

You can read Fauber and Johnson’s original and follow-up articles on the Journal Sentinel website.

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Comments (4)

According to the CDC,

According to the CDC, periodic out breaks of measles, starting in 1991 in the US, mirrored out breaks in El Salvador, Guatemala, Honduras, Jamaica, Mexico, and Nicaragua. Incidence rates were highest for Hispanics (29.5 cases per 100,000 population).
http://www.cdc.gov/mmwr/preview/mmwrhtml/00001999.htm

But again according to the CDC, importations from other countries accounted for only 1.4% cases in the US.

What is wrong with that picture?

And why did a study published in the JAMA— Pediatrics find that 88% of measles cases in the country “were internationally imported or epidemiologically or virologically linked to importation. The few cases not linked to importation were insufficient to represent endemic transmission.”

http://archpedi.jamanetwork.com/article.aspx?articleid=1787786

Why, oh why is it so hard to get a straight story from media, or the government?

Why?

First of all, this is a story about pertussis, not measles.

With respect to measles, it ceased to be endemic in the United States in 2000. The term for that is "eliminated". It then ceased to be endemic throughout all of the Americas in 2002.

This is a bit of a rudimentary geography lesson here, but there actually are countries outside of North and South America. So when Pediatrics points out that importation from other countries is the mechanism by which infectious disease cases can occur in areas where a disease is not endemic, it's somewhat tautological to point it out. And that importation in the case of measles comes from countries outside of the Americas. Ergo, blaming Latin American immigrants for causing measles outbreaks in the US is not grounded in facts.

A variety of sources like the CDC, WHO, and the Measles & Rubella Initiative all have excellent up-to-date information about measles hotspots in the world. Be sure to avail yourself of that data and then the picture will no longer be wrong.

Sometimes the story is straight but the reader isn't paying attention or is deliberately misconstruing the story.

Sources:
http://www.cdc.gov/measles/about/faqs.html
http://www.who.int/mediacentre/news/notes/2013/measles_20130117/en/

This article is about pertussis

or whooping cough, not measles ...

re Scapegoating

Thank you, Ms. Perry, for making the effort to debunk the very ugly and inaccurate scapegoating of Latino immigrants with respect to changes in pertussis incidence. Also thank you for referring to the portion of Fauber and Johnson's coverage that relies upon CDC data and analysis.

However, it's troubling to see scapegoating of one group debunked only to scapegoat another group. First is the quote of Fauber and Johnson in the third paragraph, "a proliferation of wary parents and anti-vaccine websites", concluding with a four paragraph section at the end of your piece that harps on "clusters" or "pockets" of unvaccinated children, even invoking measles immunization rates, which of course have zero relevance with respect to pertussis prevention.

Like with most infectious diseases, the CDC has good introductory information, usually including an FAQ, that Fauber and Johnson appear to have read. It's important to actually quote what that FAQ says.

First they address the increased number of cases.

"Q: Why are reported cases of pertussis increasing?

A: Since the early 1980s, there has been an overall trend of an increase in reported pertussis cases. Pertussis is naturally cyclic in nature, with peaks in disease every 3-5 years. But for the past 20-30 years, we've seen the peaks getting higher and overall case counts going up. There are several reasons that help explain why we're seeing more cases as of late. These include: increased awareness, improved diagnostic tests, better reporting, more circulation of the bacteria, and waning immunity."

So there they give five reasons that help explain this phenomenon, none of which are "anti-vaxxers". They go on to expand upon why immunity is waning and that it has to do with the modern vaccine being less effective than its predecessor, its predecessor supplanted because of its side effects.

With its following question, the CDC specifically addresses whether "anti-vaxxers" are to blame.

"Q: I've heard about parents refusing to get their children vaccinated and travelers to the U.S. spreading disease; are they to blame for pertussis outbreaks?

A: Even though children who haven't received DTaP vaccines are at least 8 times more likely to get pertussis than children who received all 5 recommended doses of DTaP, they are not the driving force behind the large scale outbreaks or epidemics."

There they make it explicit that "anti-vaxxers" "are not the driving force behind the large scale [pertussis] outbreaks or epidemics." That's a crystal-clear statement from this nation's primary public health agency. Yet despite what they made crystal clear, the Fauber and Johnson coverage and this piece ignore unequivocal CDC statements on the matter and instead directly and repeatedly contradict them. That is not responsible coverage.

Though the "anti-vax" scapegoating in the media is ubiquitous, several mainstream natural and social science writers have stood up to debunk that scapegoating and to also warn of the dangers of such scapegoating.

* Tara Haelle is currently running an excellent 3-part series on Forbes entitled "15 Myths About Anti-Vaxxers, Debunked".
* Keith Kloor has also done some excellent writing about it at Discover, particularly with a piece entitled "The Disneyland Measles Outbreak Spotlights Vaccine-Averse Behavior And Generates Media Herd Narrative". Mr. Floor references the work of...
* Brendan Nyhan, a communications scholar and political scientist at Dartmouth, and
* Dan Kahan, a Yale researcher who studies science communication and risk perception and his detailed new study "Vaccine Risk Perceptions and Ad Hoc Risk Communication: An Empirical Assessment", and
* Julie Leask, a social scientist at the University of Sydney

The Measles & Rubella Initiative also has a nice blog and is a good jumping off to quality coverage and providing the essential global context of measles and rubella.

Most people are understandably uninformed about specific infectious diseases. It's my hope that coverage here going forward can stick only to causation that can be objectively established, which of course is the core of the scientific method. Contextualization of the probability of infection and risks of infection should also be made explicit in relation to other risks people generally, and specific population subgroups specifically, face.

Source:
http://www.cdc.gov/pertussis/about/faqs.html
http://www.forbes.com/sites/tarahaelle/2015/02/17/15-myths-about-anti-va...
http://blogs.discovermagazine.com/collideascape/2015/01/23/disneyland-me...
http://www.culturalcognition.net/blog/2014/1/27/who-fears-childhood-vacc...
http://www.measlesrubellainitiative.org/blog/