Published Date: 1997-10-21 23:50:00
Subject: PRO/EDR> Pertussis outbreak - Netherlands (02), response
Archive Number: 19971021.2160
PERTUSSIS OUTBREAK - NETHERLANDS (02), RESPONSE
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A ProMED-mail post
[see also:
Pertussis outbreak - Netherlands (02) 971009232752
Pertussis outbreak - Netherlands 970518213103]
Date: Tue, 14 Oct 1997 16:58:46 +0200
From: J. Schellekens and F.R. Mooi
[On October 9, 1997, ProMED-mail posted a report derived from a media
summary of an article that appeared in a well-respected magazine describing
the current state of pertussis in the Netherlands. Some of the information
was attributed by direct quotation or inference to Dr. J. Schellekens, who
has since requested an opportunity to place the information attributed to
him in context. We invite our readers to do just as Dr. Schellekens has
done, because we strive for accuracy in our postings, and also wish to post
media-based items to apprise our subscribers articles that the public is
reading about specific emerging infectious diseases. After all, the public
response may have an important impact on the outcome of a specific
outbreak, or on the field in general. The original posting of ProMED-mail
is reproduced below followed by the response of Dr. Schellekens and his
colleague Dr. Mooi for the convenience of our readers. -Mod. ES]
>PERTUSSUS OUTBREAK - NETHERLANDS (02)
>*************************************
>A ProMED-mail post
>
See Also
>Pertussis outbreak - Netherlands 970518213103>Pertussis - USA (Idaho) 971010235214
>Date: October 9, 1997
>From: Dr. James Chin
>Source: CDCP News and media sources
>Europe prepares for possible whooping cough epidemic:
>Public health officials across Europe are preparing for a continent-wide
epidemic of whooping cough >following an outbreak in the Netherlands that
is resistant to a leading vaccine. The new strain of the >infectious
disease is a mutation of the bacterium _Bordetella pertussis_ that attacks
mainly children but >can also hit adults. Eighty-nine percent of the Dutch
children who contracted it had been vaccinated. >"The mutation appeared in
the early 1980s, but now occurs in 90 percent of circulating strains," Dr
>Johannes Schellekens of the Dutch National Institute of Public Health told
New Scientist magazine on >Thursday.
>Whooping cough, a disease of the mucous membrane lining the air passages,
causes attacks of convulsive >coughing and often vomiting. It is more
prevalent in girls than boys and usually occurs between the ages >of one
and four. Nearly 3,000 cases have already been reported in the
Netherlands, compared to just 321 in >1995. Danish health officials have
treated 179 children so far, more than double last year's figure. The >same
mutation has already been spotted in Finland, Italy, Germany, France and
possibly Belgium. The >likelihood of the mutant strain of the disease
spreading across the continent will depend on which type of >vaccine a
country uses. The whole cell vaccine used by the Dutch has been
ineffective. But other vaccines >in England and Finland, which give
immunity to pertactin and other proteins, will help sufferers fight the
>disease. "In such cases the mutation may cause a smaller or later
epidemic," said Schellekens. During the >last epidemic in Britain in the
late 1970s, 102,500 cases were reported, including 36 deaths.
>--
>Dr. James Chin
>e-mail: jchin@cdpc.com
...............................
The following is the response of Drs. Schellekens and Mooi:
The recent update on the 1996/1997 pertussis epidemic in the Netherlands
which appeared on this site (October 9, 1997) contains highly unjustified
statements and conclusions. The message was, in fact, derived from a press
release by REUTERS summarising an article in the periodical "New Scientist"
of October 10th. In the latter article, it is stated as a fact that a new
"mutant" strain of _Bordetella pertussis_ has arisen which is resistant to
the Dutch whole cell vaccine and that this strain is expected to spread
over Europe causing a large epidemic. Further, the reader is led to
believe that these statements were made by one of us (JS). This is not the
case. Highly theoretical speculations about the many possible causes for
upsurges of the incidence of pertussis in vaccinated populations have been
used, filtered and wrongly reported as established facts. To stop the
spread of this misinformation, we would like to state the following. We
have observed antigenic shifts in the _B.pertussis_ populations in the
Netherlands, but also in other European countries (some of which do not
show an upsurge of pertussis). Whether or not these shifts affect vaccine
efficacy and are the cause of the upsurge of pertussis has not been
established. For more information, the interested reader is referred to
our original report on the pertussis epidemic in the Netherlands (Emerging
Infectious Diseases 1997; 3: 175-8).
[The Emerging Infectious Diseases paper has been previously summarized by
ProMED-mail, see archive number above. The following is a quotation from
particularly relevant sections: "Although not all potential surveillance
artifacts could be excluded, it is highly probable that the surveillance
data reflect a true pertussis outbreak. The outbreak could have been caused
by 1) decrease in vaccination coverage, 2) decrease in vaccine quality, 3)
interference with other vaccines, 4) changes in circulating strains of B.
pertussis that are not covered by vaccine-induced immunity, or 5) a
combination of these factors." -Mod. ES.
[I have communicated with Dr. Schellekens concerning the precise nature of
his objections to the original message, and it should be noted that he has
also confirmed the accuracy of the numbers of pertussis cases seen in the
Netherlands and the vaccination status of the patients. He has further
made it clear to me that he considers it improper to conclude from existing
data that the Dutch whole cell vaccine has been ineffective. He believes
that randomized, controlled trials would be needed before this conclusion
could be drawn.
Thanks to Dr. Schellekens for his thoughtful and comprehensive response to
my request for clarification. We make every effort to maintain scientific
quality and to stimulate useful discussion, and I would say that Dr.
Schellekens has raised the level of discussion in this thread considerably.
-Mod. ES
--
Joop Schellekens
e-mail: j.schellekens@rivm.nl
Frits R. Mooi
e-mail: fr.mooi@rivm.nl
National Institute for Public Health and Environment (RIVM),
The Netherlands
.........................................pc/es
--
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