Recently I went to get my pertussis booster. I got the combined DTaP shot, which includes vaccinations against diptheria and tetanus. While I am actually pretty sure I had a tetanus shot before traveling just a few years ago, I didn’t think there would be any harm in repeating this vaccination. The injection site was swollen and hard for almost a week, but aside from that, I experienced no side effects, except for the smug satisfaction that comes along with actually getting an annoying task like that completed. It’s a hassle to make an appointment at the doctor when you’re working and taking care of kids–and when nothing is really wrong with you.
In addition to the annoyance of scheduling a vaccination and going to the doctor, it looks like insurance might not be covering these booster shots, in spite of the epidemic levels of pertussis here in California. When I called to make the appointment, the receptionist informed me that insurance wouldn’t cover the shot, but I decided to get it anyway. The doctor knew a little about the epidemic, but she was somewhat surprised that I was there in her office for a booster. She agreed that I should get the shot. I am a teacher, so any epidemic will reach me at work, and I spend a lot of time around families with kids, including newborn babies, who are the most vulnerable to pertussis. But still, the doctor had not had anyone else in her office demanding a booster, and she was surprised to see me there. So no one gave me a lollipop and a pat on the back for being a good citizen and getting the shot. There was no prize except a few hours out of my day and a quarter sized lump on my shoulder. Oh, and the smugness. And well, also there’s just knowing that I can’t infect a baby with whooping cough. You know, that’s a relief, for sure.
When it was over, I was expecting a demand for payment since I’d been told the injection wasn’t covered, but no one remembered to talk to me about that. So I did what any self respecting person might do: I walked out of the office. They can bill me if they need to. As my Great Uncle Sid used to say: “I owe you money? Why should two people worry?”
So look, I know this is not a fun assignment, but go and get your booster shot. My husband still hasn’t made his appointment, so I’m going to have to be the nagging wife on this issue. And I’m sure there are a lot of adults who haven’t, because it’s just another thing to have to do.
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But here’s the thing, we might not be able to blame the anti-vaxxers for this outbreak. Pertussis doesn’t confer lifelong immunity, whether you get the vaccination or the disease. Everyone at some point will need a booster shot, and this current outbreak is not necessarily a result of people refusing to vaccinate their kids. It’s actually more likely a combination of factors–one of which is us: adults whose immunity has waned.
Steven Novella at Science Based Medicine has a post about this subject up today:
The factors, therefore, that are contributing to the fact that the current epidemic is likely to be the biggest in 50 years are – the natural cycle of pertussis, a lower degree of immunity from the current DTaP vaccine vs the older DTP vaccine, and waning immunity in older children and adults with low rates of booster shots to maintain immunity.
The other factor mentioned is that there are lower rates of vaccination in undocumented immigrants. The incidence of pertussis in Hispanic infants has been higher than in other populations. This makes sense to anyone familiar with the general trends of immigration, as I am from working in a school with many undocumented immigrants. Many immigrants probably did not receive this injection as young children and would have immigrated as older children or adults to the U.S. With no immunity in place within a family, any newborn infants would be more susceptible to encountering a disease brought home by adults or older children.
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It is tempting to blame this outbreak on the fear of vaccines and low vaccination rates, but that might be an oversimplification. Steven Novella does make the point, however, that with the school year starting in a couple weeks, it might be true that low vaccination rates will worsen the outbreak. In addition, one fact not mentioned in Novella’s post is that California is actually only one of eleven states that does not require a middle school booster against pertussis. So that’s probably not helping too much.
I hope that the Department of Health will be offering low cost vaccinations soon. And my sincere hope is that schools like the one where I teach, which service a largely adult Hispanic population, will be targeted as places where the vaccine can be offered. With the incredible budget crisis here in California and the devastation that schools have suffered this year, it will be interesting to see how much can be done.
But in the meantime, for those of us who are lucky enough to have insurance and a family doctor, make the appointment and get it done. It’s a hassle but it is definitely worth it. The worst story I have read about this epidemic involved a mother who gave whooping cough to her own newborn, who died at 17 days old. It’s a very disturbing read, but here’s the link. If nothing else motivates you to get your booster, this should do the trick.