Whooping cough is back. That is, the disease, which killed hundreds of children a year until the 1950s, never quite disappeared from the Netherlands following an unexpected new epidemic in 1996. Despite standard vaccinations of all babies, the epidemic has not been eradicated, in fact, the number of cases is increasing.

”As if it came from the bottom her lungs….the fits of coughing were so intense they regularly made her throw up…….really made you think like, oh! she’s going to choke……with big, bulging eyes and purple in the face. It looked really serious”

Johan van der Tol told us about when his 6-year-old daughter suffered from whooping cough. She survived, but then again, she was no longer a baby.

Hundreds of thousands of victims
Worldwide, hundreds of thousands of babies die of whooping cough every year, and not just in poor countries. Young epidemiologist Sabine de Greeff at the RIVM, the National Institute for Public Health and the Environment paints a gloomy picture:

”Whooping cough really occurs across the whole world with current outbreaks in Ireland and California. And some children there have died of whooping cough”.

Extreme fits of coughing
Whooping cough is extremely contagious and dangerous to young babies. Even when they survive the infection, the consequences can be very serious. Severe fits of coughing can cause broken ribs and even permanent brain damage. This explains why the whooping cough vaccine has been standardly included in a cocktail vaccination against a number of childhood diseases. The vaccination provides protection for about five years, after which period the most serious danger is over as the child is no longer a baby.

Many people believe that whooping cough is no longer a problem in the Netherlands. And it is true that the official vaccination programme nearly succeeded in eradicating the disease after the 1950s. However, in 1996 the health care inspectorate unexpectedly raised the alarm: the number of infections had suddenly jumped to 4,000 from a normal level of about 300 a year.

And the number has remained 10 times higher than in previous years. Each year, 200 children are admitted to hospital and a number of them die of the disease.

Vaccination pressure
According to Sabine De Greeff, the official vaccination programme is partly responsible for the resurgence of whooping cough: it’s a problem known as ‘vaccination pressure’.

”People are developing immunity against the whooping cough bacteria as a result of the extensive vaccination programme. However, the bacteria naturally wants to survive and has started to adapt. It’s trying to get stronger in order to survive. So this is in fact a result of consistent vaccination.”

Stopgap measure
Apparently, the super whooping cough bacteria has become a reality. The ideal weapon against the stronger, mutated germ would be a new, more powerful and longer-lasting vaccine. However, developing a new vaccine would cost a fortune, and the pharmaceutical industry does not like the idea. They would much rather continue to produce the old vaccine. Its development costs have long since been recovered, so each additional dose sold is pure profit. But it also gives the bacteria the opportunity to become even stronger.

Cost control
Sabine de Greeff regrets the current state of affairs, but understands that the pharmaceutical industry is not going to invest millions on the say-so of a young Dutch scientist. Which is why the conclusion of her Ph D thesis is a paradigm of Dutch level-headedness: “Vaccinate all young parents one more time with the existing vaccine. It is probably powerful enough at least to ensure they will no longer be able to infect their babies. And also, it will keep costs down”.