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Dutch doctors warn parents over whooping cough vaccine

Utrecht Tony Sheldon

Dutch doctors have warned parents not to delay vaccinating their children against whooping cough, caused by Bordetella pertussis, as serious cases could require hospital treatment and may result in death. The Dutch Paediatrics Association emphasises that eight children have died in the Netherlands from whooping cough since 1996. None had been vaccinated.

Fears about delayed vaccination have arisen because, although a more effective vaccine with fewer adverse reactions is to be introduced as part of the national vaccination programme, this will not happen until 2005, as stocks have to be imported.

The introduction has coincided with a new whooping cough epidemic and a general decline in vaccination rates amid concerns about the current vaccine.

The Institute for Public Health and the Environment (the RIVM) in Bilthoven reported 1030 cases of whooping cough in July, compared with an average monthly figure of between 200 and 400. The institute says the falling vaccination levels have not caused the epidemic but may make it worse.

The government decided to introduce an acellular whooping cough vaccine as part of combined vaccination against diphtheria, tetanus, polio, and Haemophilus influenzae type B infections (DaKTP-Hib). The effectiveness of the current vaccine is believed to have declined owing to the emergence of a non-vaccine related strain of pertussis.

The acellular vaccine, consisting of a few purified proteins of B pertussis and pertussis toxin rather than the whole cell, also results in fewer adverse reactions, such as febrile convulsions and protracted crying. These reactions rarely cause long term physical effects but are distressing, and their incidence would fall, the Dutch Health Council suggests, from 1.4% to 0.3% of all vaccinations (which total 8000 a year).

But in the meantime the Vaccine Institute is urging parents not to postpone vaccination until the new vaccine is available. "It cannot be emphasised enough how important it is to continue with the current vaccine," it says, arguing that the vaccine offers protection against serious cases of whooping cough requiring hospital treatment. The Paediatrics Association agrees, arguing that delaying vaccination in expectation of the new vaccine was taking an "irresponsibly high risk."

Paediatrician Dr Hans Rümke of Rotterdam’s Sophia Children’s Hospital argued that, given the current epidemic, to delay vaccination until 2005 left children (especially the youngest) at risk, and it was "conceivable" that problems, including deaths, would result.

The current epidemic follows a predicable pattern, which saw peaks of whooping cough in 1996, 1999, and 2001. The July figures, however, are the highest ever. This could be due to better reporting. It will not be clear until the late autumn, when the whooping cough epidemic will peak, how extreme the current epidemic is.

The Dutch Health Inspectorate has warned that group immunity has been weakened by a general decline in all vaccination rates for children aged under 12 months. In particular, in two of the 12 provinces in Netherlands—Flevoland and Zeeland—vaccination rates for whooping cough in infants are only 92.6% and 90.9% respectively. It notes a "worrying" sharp fall of 2% in Flevoland.
 

Rapid Responses:

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SCARIER VACCINE STORIES MEAN LEGAL LIABILITY FOR GPs

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Re: Re: Wibble; history; science

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