Sawbones: A Marital Tour of Misguided Medicine - Sawbones: Whooping Cough

Episode Date: January 28, 2025

Depending on where you live, you might be hearing a lot lately about Pertussis or Whooping Cough, even in Dr. Sydnee and Justin’s home county. Dr. Sydnee talks about the long history of this disease, its symptoms, and how the vaccine eventually came about.Music: "Medicines" by The Taxpayers https://taxpayers.bandcamp.com/Palestine Children's Relief Fund: https://www.pcrf.net/

Sawbones is a show about medical history, and nothing the hosts say should be taken as medical advice or opinion. It's for fun. Can't you just have fun for an hour and not try to diagnose your mystery boil? We think you've earned it. Just sit back, relax, and enjoy a moment of distraction from that weird growth. You're worth it. Alright, this one is about some books.

One, two, one, of misguided medicine. for the mouth. Oh, it's when we fell down. Hello, everybody, and welcome to Sawbones, a battle tour of misguided medicine. I'm your co-host, Justin McElroy. And I'm Sydney McElroy. I left the heater on, Sydney. I'm realizing in my effort to not lose toes to frostbite down here in the McElroy Family Studios Midwest,

I have to turn the heater off. Midwest? Yeah. This is not the Midwest. Appalachia, is that better? McRoy Studios, Appalachia? I don't know, so Appalachia would be fair. Yeah, we are the only, we are the only

McRoy Family Studio, well no, your dad, well. I mean, according to the- Well, he's in Appalachia. According to SAG-AFTRA, me, Travis, and Griffin are all part of the Mid-Atlantic region, but I don't think that's I It's better that we are not we this is not Midwest. There's a lot of dispute as to whether West, Virginia is We're not northeast. No, but we're not

The south certainly not the south don't mess that up Anyway, I don't think anyone know Appalachia. We are state is entirely subsumed in Appalachia. We are Appalachia. We are Appalachia. We are Appalachia. And don't come at me with any Appalachian. Whoa. It's Appalachia.

Wow, okay, so Sydney, today we're talking about pronunciation and why that figures into medicine. I don't know, but I'm looking forward to finding out. I feel like that's a valid intro though for something that's called pertussis or whooping cough. Whooping cough. Or do you prefer whooping cough?

Whooping cough, it's a whooping. Whooping, whooping. That is a very Appalachian term. I really hope that it has an Appalachian terminology. I feel like it's probably not gonna be a very Appalachian term. I really hope that it has an Appalachian terminology. I feel like it's probably not gonna be authentically Appalachian. It's not. Can I tell you, I am shocked

we have not done an episode on this. I was so convinced. I thought it was like a classic disease, like surely. One of the classic diseases. In sawbones, the early years, we must have covered. Or at least in the college years. I Googled several times, I searched through all of my drive,

and then I had to go- That's been running a little low this month, I don't know about you. No. My drive has been running. And then I had to search through, I had to resurrect my old laptop to look through my- Did you open, did you go into open office?

Yes. Did you dig through your ODTs? I dug through my ODTs, which are a little glitchy. It kept crashing. I don't think- Down in the archives. I meant to ask you, is there a way to put those in my drive?

No. Listeners, don't email me. They're all my show notes from our earliest ones when I was still using OpenOffice. Just do what I've been insisting you do. Send it to the Smithsonian. They will be the best people to handle it. They'll know the way to deal with it, honey.

I can't be, I don't even have the gloves that they use. I was, I don't remember, I was using ODT, I was using OpenOffice well past when it was acceptable for me to not put these on a Google Drive or some other sort of cloud-based, I don't, it doesn't have, whatever, some sort of drive. You fought the good fight for the Open, Open software. You know what we're gonna get now.

We're gonna get a lot of emails from a lot of word processing dorks. We're like, actually, open offices stuff, can you, for me, please. Don't call them dorks. They know, honey. At this point, they know. They know a lot more about something that I obviously know almost nothing about. Okay, so whooping cough, Sydney, whooping cough. So I think it depends on where you live in the country right now. You may be hearing a lot about pertussis or whooping cough.

It's the same thing. Or you might not. I know that currently there is an outbreak right here in the county in which we live. Did you know that Justin? In the good old, well I do only because you mentioned it and because, well actually I've seen it on the news, but yes I do know that. And there are a lot of people kind of freaking out. I think they're like, oh my gosh, vaccine requirements have changed.

And now we have whooping cough. Well, OK, that's not nothing has changed yet. Right. So that's not why. They are changing here in West Virginia, though. They wasted no time on our vaccine recommendations here, easing those. Yeah, our complete idiot governor. Wow, not a lot of daylight,

not a room for equivocating there about our stupid, horrible carpet bagger idiot governor. Who worked on behalf of the big pharmaceutical companies that helped destroy, or tried to destroy, we will not be destroyed. We will not be destroyed, Patrick. Who is now our governor. The one of the, oh man.

He's just one of the worst people. It's like Jim Justice without the dog. I mean, if you thought, I mean, you're all gonna listen, welcome to Jim Justice, rest of the country. Oh, wait, have you all not met Jim Justice? You're gonna love it, he's broke. He's our Senator now. He's our broke Senator who missed his first two votes

because he doesn't like to do that. He likes to coach basketball. Did you see the picture of him rolling up to the airport in DC? And there is a, did you see it? And Baby Dog in the wagon. He's in the scooter behind and no one's even clocking him. And then Baby Dog's in front of him and all the photos

and everyone's taking pictures of Baby Dog. Hey guys, you are welcome. I will say this, America, if during the darkest times, you wanna have a laugh at Jim Justice to perk your spirits up, we have been doing that in West Virginia for quite some time. It's okay.

It doesn't make you a bad person to laugh sometimes at Jim Justice and Baby Dog. It will help you to get through some of the harder times. We can, here in the Resistance, we've been laughing at Jim Justice for a long time. Yes, you can enjoy him and his dog. And also, we have processed over here the difficulty of loving Baby Dog despite his owner.

It is okay, that work is done, that labor is settled. You don't have to deal with that guilt. Baby Dog's fine. You can like the dog. You work is done, that labor is settled, you don't have to deal with that guilt, baby dog's fine. You can like the dog. You can like baby dog, this is settled. We here in West Virginia, our stupid governor has issued an executive order lifting or allowing for a religious exemption to vaccine mandates.

We have not had that in West Virginia. West Virginia has been well ahead of other states in terms of strong vaccine mandates to protect people, especially children in our state. We have lost that distinction just this year, thanks to Governor Morrissey, because now we allow you to bring some piece of paper to your school that says,

my religion says no vaccines, and then you don't have to get vaccines. And that's obviously dangerous. So we may see more vaccine preventable diseases, we certainly will. And if RFK becomes whatever Trump decides he's gonna become, we'll probably see even more vaccine mandates lifted.

So let's talk about pertussis. Let's talk about taking action so you don't have to feel afraid. Because I think sometimes with these older diseases, we just get this sense that they were really bad and they killed everybody. And then we got vaccines and thank goodness, and now we're fine.

Before that, everybody died. Right, and that now if vaccines, if people aren't getting vaccines, we're all gonna die again. And that is not true. Is there a reason to be concerned and take it seriously? Absolutely, but panicking doesn't help us right now

because there's actions you can take. So Pertussis outbreaks have been around since the 1500s that we know of probably before that, but that's when you start to see descriptions of Pertussis outbreaks. I thought this was really interesting because as I was researching, like who first described pertussis, usually that's what you find kind of in like

the evolution of a disease, our concept of a disease, is you see some old timey physicians who wrote like clinical descriptions. I'm seeing this disease process. It presents like this, it tends to strike this age group. These are the symptoms, this is what happens next. And you see these clinical descriptions of something and they usually give it some sort of weird name,

or like random, like just like the cough or something. And then it's a while before we connect that to any kind of germ or certainly an even longer while before we connect it to a treatment or a vaccine. Does that make sense? Yeah, for sure. We have diseases, we've talked about them, I think that have probably cloaked their existence

for a long time because they have a similarity to another preexisting disease. So it probably took longer to like root out some of those. Exactly. Oh, this isn't a common cough. This isn't whatever, it's something new. Yes, yes. I mean like- And think about how wild that would need to be

to you need a lot of people experiencing it like at different places, right? Before it starts to become something that's like, oh, you know, this is different. I think it's a new thing, especially when we can't perceive a lot of that stuff without tools and what have you. Without the right diagnostic tools, we didn't have them yet.

So the credit for first describing this is most commonly given to a French physician named Guillermo de Bayou, who is also called the father of modern epidemiology. He wrote a lot about epidemiological methods of tracing disease, followed in Hippocrates' footsteps in the way he viewed medicine, and in 1578,

he wrote a clinical description of an outbreak of a respiratory disease in Paris. He was also often called the Sydenham of France, so. Mm, the, the, the Sydenham of France, you don't say. Well, I mean, I don't Sydenham of France, you don't say? Well, I mean, I don't think I need to tell, I mean, of all the people, I don't need to tell you that Sydenham is a civil parish in Southeast London. That's not, Thomas.

Dang it, okay, hold on. Thomas Sydenham, famous English physician. Ah, yes, famous for Observations Medicaid, which became a standard textbook of medicine. There you go. For two centuries, if I'm not mistaken. We've talked about him a lot on the show. A lot of people call him the English Hippocrates,

making this person the French English Hippocrates. So he wrote this description back in 1578 of mainly kids between four and 10 months who got fevers and then a cough. They said that they at the time would call it the quinta or quintana is what they would call the cough. You would get this lung irritation. It could be pretty severe.

And then all of a sudden your throat would swell up and you would get this lung irritation, it could be pretty severe, and then all of a sudden your throat would swell up and you would get this sort of strange cough where it was like you couldn't get air out. You can see where this is going to go eventually. Why it was called the Quinta even says, he's not really sure why at the time. They thought maybe that the cough sort of sounded like Quinta,

which is hard for me to, I kept trying to- Quinta, Quinta, like that? Well, that's not, I mean, we're gonna get to the point where we call it whooping cough. Is it maybe- Because it sounds like a whoop. Maybe everybody got it at a La Quinta. So they called it that because they all were at the La Quinta at the time.

I don't think La Quinta was around yet. You don't think? I don't think. It's a fabled, storied brand. I mean, I guess, think? I don't think. It's a fabled story brand, I mean, I guess, maybe, I don't know. Others think it's because Quintana is because it repeats every four to five hours,

which there are paroxysms of the cough. So we'll get to, there's different phases, but like the idea that for a while, you're not coughing a lot, and then you would get this sort of bout of intense coughing with this weird sound that you would make. This is true. Now I don't know that every four to five hours

is necessarily the case, but so maybe it came from there. But anyway, there was this description, there wasn't a lot about like what to do or anything, just like this happened. Now what was interesting is as I was reading about the history of pertussis, there's some dispute here because this is from 1578, but then I found this other article from an Iranian medical journal that talked about the first report of epidemic pertussis

which was actually in 1502 from a Persian lithograph from 1502. This report actually comes from Bahadur Razi who was a very well-known Persian physician. But I think that what is really interesting is there's a complete description of the disease itself, which he called, there were two epidemics in Harat and one in Ray. He reported on them, like I said, this is like a century before Bayou does it.

And he named it public cough. Public cough. For what he called cough. Public cough. For what he called it. Okay. Public cough. But he talked about the idea that maybe this is some sort of agent that enters the lungs via some sort of pollution.

He was very focused on the idea that maybe pollution could lead to this, especially like moisture in the air. Perhaps a miasma. Yes, I mean, this is kind of similar to a miasma theory of disease, definitely. But I mean, it is an infectious agent that enters through the lungs is accurate. Yes, so he's not wrong.

He's not wrong. So, and then you get this cough, and then you get the periods of cough that are so severe that you could stop breathing, that you turn blue. He talks about how you cough so hard you turn blue, that some people die from it, that children seem to get it more.

And then even throughout there that maybe ginger would be something effective at treating it. And so I think what is interesting, and then it was funny, because then I was reading another article where they just had a sideways mention of, while we typically credit this French physician with the first description of this,

there was probably an earlier Korean text that mentioned it. I couldn't find where they were referencing. But I think what the point is, is that, and this is important for sawbones in general, we get so hung up on Western texts and descriptions of medicine. This is a common problem. And I'm not gonna speak for the entire scientific community,

but I know it happens in medical history a lot. And we disregard anything that didn't come from the West. It happened there first, and it's somewhere in Europe or the UK or the US wants to claim it. It doesn't become legitimized until Western medicine like recognizes it. Exactly, which I just think is important to point out that it is when you're looking for the history of something expanding your search beyond where you usually look and the countries

and the origins, you know, it's not just Hippocrates. It's not just Hippocrates. I think it's an important reminder to us. But anyway, we didn't know exactly what pertussis was yet. We have these descriptions of this cough. We kind of know that it hits kids worse than adults. We know that it tends to look like a cold at first, but then it gets these terrible coughing spasms and that you could stop breathing and die from these terrible coughing spasms.

We have this suggestion that maybe ginger helps but we're not really sure and we know that it's spread, it seems to be spread or at least we wouldn't have known necessarily person to person but we definitely see it as an outbreak type thing right? Whether or not I'm giving it to you or it's the air we're both breathing one way or another it's something that people get in big groups. It's not an isolated disease but in order to figure out what it is and how we stop it you've really got to figure out what it is and how we stop it, you've really got to figure out what the, well, first we have to believe in germs.

Yeah. Germs believed in us, but we didn't yet believe in germs. Germs knew we were all around. Germs had faith. Germs had faith in us, but we didn't have faith in germs yet. That didn't come until the germ theory of disease. And then that's when we start digging around

to try to figure out like, okay, you're sick, I need to get some of your sputum, and I need to look at it under a microscope, or I'm gonna take a, if it's something else, I'm gonna take a piece of your liver, I'm gonna take an autopsy and take chunks along, whatever. We're gonna look at things, try to find the germ, find the bug.

And then in 1906 is when we finally were able to isolate the organism. There were a bunch of organisms being found thought possibly pertussis. They went through the same, yeah, I don't wanna belabor it, but you go through the process. You take some stuff from a sick person, you look at it under a microscope, you find this bacteria,

you put that bacteria in an animal probably, not usually another human, we weren't doing that all the time. And then see if the animal gets sick with the same thing, and then you would take it out of the piece of the animal, look at it under a microscope, do you see the same bug? There you go, right? Yeah. Okay.

Got a vaccine. And they found Bordetella pertussis, the bacteria responsible for pertussis, which we then named pertussis because. Because the name. Because the name, yeah, you wouldn't have called it pertussis first, that would have been Pertussis because. Because the name. Because the name, yeah. You wouldn't have called it Pertussis first. That would have been.

But then once we figured it out. Wild, and this is a critical step. If you're gonna know treatments, cures, vaccines, you gotta get the bacteria or virus, the agent that is responsible for it, and then we can start testing it to give us different things to fix it, and we can start working on a vaccine against it

because we gotta figure out what piece of it makes your immune system react and how can we put that piece of it in you without making you sick. So what does pertussis do and how do we fight it? I'm gonna tell you after we go to the billing department. Let's go. The medicines, the medicines

that escalate my cough for the mouth All right, Sydney, I'm ready to do my part against pertussis. First of all, I think it's important to understand sort of the process of pertussis. Like what is whooping cough? What is it? What happens? What does it look like? How would you know if you had it?

So the bacteria is mainly gonna attach to, there are these little hair-like projections of pertussis, like what is whooping cough? What is it, what happens? What does it look like? How would you know if you had it? So the bacteria is mainly gonna attach to, there are these little hair-like projections called cilia that line our airways. And the bacteria attaches to those and then releases this toxin that creates a lot of swelling and inflammation. This is why you get some of the most distinctive symptoms.

If you just got really super swollen airways, which makes breathing hard. And why you can have worse clinical outcomes from it, depending on if you get treated or not. It is spread through close contact, spread through the air and droplets. So breathing around somebody can give it to them. Obviously coughing around them.

And then following exposure, it takes about five, seven days before you're gonna get any symptoms. So that's your incubation period. There are three phases of this disease. The first is that incubation phase where the bacteria has gotten in you from another person and now it's growing, it's multiplying and growing.

Then follows what's called the cataral phase. This is gonna look like a cold. At first, you're not necessarily- Cataral? Cataral. Cataral, okay. Cataral. And you're gonna have cough, maybe sore throat,

fevers, chills. You're gonna look like you've got a cold. This would be the easiest time for us to diagnose it because you're actually gonna have a lot of the bacteria in your system at this time. So like if we were to test you for it, we would be most likely to catch it at this point. The problem is it looks like a cold

and not everybody is gonna go in and get checked out. And even if you do, my index of suspicion that it's whooping cough. What does that mean? I mean, I guess we know with two context what that means. Yeah, like how concerned I would be,

how high that would be on my list of diagnoses. If I have a differential diagnosis. So when somebody comes in sick, the thing that the doctor should be doing in their head is creating a list that is a differential diagnosis. What do I think you could possibly have? Now, sometimes that list is like, it's one thing, I took your blood pressure, it's high,

you have high blood pressure. Sometimes it's pretty straightforward. But with something like a respiratory illness, that list is pretty long. And a lot of the stuff on it we don't even know, because then there's all the random viruses we can't test for that we just say, I got a cold. Just stuff happening.

So if you come in with cold like symptoms, especially this time of year, I'm not gonna initially think whooping cough. So I'm not gonna test you for whooping cough. So you're gonna go home, and maybe I said like you don't have flu or COVID because everybody tests for that now, but I didn't tell you anything else.

Then it's gonna evolve into the next phase, which is this severe paroxysmal cough, meaning comes and goes with a tonic. Paroxysmal? Comes and goes. Paroxysmal, comes and goes. With severe mucus secretion, and then that can even lead to what we call

post tussive emesis. That means post, after, tussive, cough, emesis, throw up. You cough so hard you puke. Got it. That can happen with other illnesses as well. That's a common concern. So do you think someone said he coughs so hard he puked and then one of his other doctor friends is like,

wow, that took so long. I got so bored while you were saying that. We gotta come up with a faster, more complicated way of saying coughs so hard he puked. Post-tussive emesis. Nailed it. Got it one, Greg. I'm glad we keep you around.

Which again, that is not unique to pertussis. It can have, I mean, it definitely happens in pertussis. I mean, it's coughing so hard you throw up. So it seems like anything that makes you cough hard, right? Yes, that can happen with lots of things. So the coughing fits because you're coughing really hard because your airways are really swollen and you're trying to get all of this mucus out, okay?

And when you do that there was this sound that a lot of people with it, especially children with it, tended to make which sounded like whooping. This is where the name whooping cough starts to... How would you define whooping though? Are you trying to make me whoop? No it's just you said it sounds like whooping so what does that sound like? Whooping I mean. I've never, I know I've had, I've taken care of patients with whooping cough.

I would not say that I thought that they sounded like they were whooping. But obviously back in the 1900s, people very much thought that they sounded like they were whooping because they called it whooping cough. Honey, if you haven't whooped yet, I don't know what to tell you at this point in your life. I mean, I've been whooping, I don't know,

several times a day. You should have started whooping a while ago. That's what I'm saying. I don't know what to tell you. What are you scared of? What do you think a whooping sounds like? Like a whoop. Do a whoop.

Like whoop, there it is. No, I don't think that's the sound they're making when they cough. Whoop, I coughed. No. Whoop! Tag team back again. Coughing so hard, no lose a friend. What I would say is these are tightened airways.

And so they're gonna make high, not like that, but they're gonna make high pitched sounds. Basically. This is gonna last for like two weeks. So it's a long. God, I would leave. If someone sounded like that, can you imagine that for two weeks of that?

I don't think it's exactly like that. Woof, no thank you. What makes us a diagnostic challenge is that at this point, if I test you for it, you actually have less of it in your blood. What we're dealing with is that the toxin that was released is what's causing this at this point, not the bacteria itself. So it's hard for me to find it in you

because now all that we're dealing with are the consequences of all that toxin. Does that make sense? Yeah, I think so. So it made it a bit, now I will say back in the 1900s when there were multiple outbreaks of this, it would have been much easier to diagnose because you would see it a ton.

So like as a physician practicing, I would see so many cases of it, that it would be easy for me to diagnostically recognize it. I think the challenge nowadays is it's hard to test for at this point. And most of us have not routinely seen whooping cough in our careers. That's what we're up against now.

Now, as with most respiratory illnesses, if you have preexisting lung problems, it could be worse for you. And then specifically for pertussis children and especially infants tended to get it the worst. As with most respiratory illnesses, if you have preexisting lung problems, it could be worse for you. And then specifically for pertussis, children and especially infants tended to get it the worst. That's where we see the scariest disease progress is among the youngest patients.

And throughout the 1900s, you saw seasonal outbreaks with as high as 10% mortality rate in children. So it was a big deal for sure. Whenever there's something like this that is a big deal, we start thinking instead of just treating, which is great, treatment is great, is there a way to prevent it? Can we make a vaccine and prevent this disease?

They came up with one, it's kind of interesting, pretty quickly after 1906 when we discovered the bacteria, they came up with a vaccine that's kind of interesting, pretty quickly after 1906 when we discovered the bacteria, they came up with a vaccine that would help with the symptoms of it. It was almost like, it wasn't a prevention. It was once you get it, we could give you a vaccine

that would help. That was not very popular. It took a while to come up with one that could actually prevent it. And what's nice is that only humans host pertussis. That makes it a little easier, right? You can, I found some cases where we did accidentally give it to animals in zoos, like non-human primates in zoos.

So it is possible through prolonged contact with humans that you could give it to another primate. All right, good to know. I'm sure the gorillas would really appreciate that. So don't, if you have Pertussis, please stay away from the gorillas, I guess. Yeah, they've got it hard enough. But generally, we are the only host for this.

So it took a while, they started working on, like I said, here's what you have to do when you make a vaccine. You're either gonna take the whole bacteria, find a way to make it inactive, so it can't make you sick, and then a way to get it in your body so that you get an immune response without an illness, or you're gonna take pieces of it.

Well, initially in 1939, they made a whole cell vaccine. Basically, they took the entire bacteria, they inactivated it, and then injected it in people, and you got a really robust, strong, meaning strong immune response. Good. So this was good. This is all the way back in 1939.

In the late 1940s, and you probably have heard of this, they very classically combined vaccines back then, anytime that they could, instead of giving you, you know, 20 shots, the more we can combine so that you get fewer needles, the better. And they combined it in the late 1940s with diphtheria and tetanus vaccines to become the DTP or now it's called the DTAP

but it wasn't then. DTAP. No, and I'll tell you why. At the time it was the DTP, okay? So great, we have this great vaccine that has a whole cell inactivated pertussis vaccine in it, it's got a diphtheria vaccine in it, and it's got a tetanus vaccine in it.

Those are other diseases we've talked about on other episodes. However, even though we were seeing like this great success from it, so as you move into like the 80s, with the pertussis vaccine, with vaccine mandates, with childhood vaccine schedules, you're seeing fewer and fewer cases of whooping cough.

Right? This is great. But what happened with whooping cough is the same story that happened with a lot of these vaccine preventable diseases. As you stop seeing the worst cases, when you get to generations of people like us, who have never seen a child struggle with pertussis. I've never seen that. I don't know what that would be like.

I certainly as a parent don't know the terror of that. You start to get people shifting towards focus on the side effects of the vaccine. Now, in many cases, the concern over vaccine effects is not true, it's stuff that people made up or- Completely invented. Misattributed, whatever. The thing with the pertussis vaccine in particular is that it was a whole cell vaccine, it was very reactogenic,

meaning it got a really strong immune response, but it also did have some local inflammation as side effects. So like you could get a fever, you could get some redness and swelling at the injection site. It was a little more likely to trigger some of those things. And because we were giving it to kids, what you could also see is that it triggered a fever,

and then it is possible because we know that febrile seizures are a thing, that some people, especially in children, they can get a fever and have a seizure afterwards. There were some cases of that. This is not unique to the pertussis vaccine or to any side effects. It's just that can happen with fevers.

So anyway, the focus starts to shift on, are there problems with this vaccine? Is it dangerous? Should we be giving it to kids? All of the usual rhetoric, the vaccine is worse than the disease. That isn't true. But if you've worse than the disease. That isn't true. But if you've never seen the disease.

Maybe you think that. You think that. So you start seeing the wholesale pertussis vaccine being blamed for a bunch of stuff. There's a TV documentary. There was a group form called Dissatisfied Parents Together. And then they became the National Vaccine Information Center,

which continues to provide a lot of misinformation about vaccines. A bunch of parents refused to vaccinate their kids. There were personal injury lawsuits. Congress passed the National Childhood Vaccine Injury Act to protect vaccine manufacturers, but now it is... Anyway, the point is there was all of this concern. Yeah.

And we see people not taking the vaccine, and at this point, it's rolled in with diphtheria and tetanus, so they're not getting any of those because everybody's freaking out about the whole cell pertussis vaccine. And I say whole cell pertussis vaccine because at this point, there was a Japanese physician or Japanese scientist, Yuji Sato,

who started working on an A cellular pertussis vaccine, basically said, hey, what if we just take the parts of it that get the immune reaction and put that in a vaccine instead of the entire cell? So he took the toxin and another aspect, the filamentous hemagglutinin created an Acellular Pertussis vaccine, introduced it at first in Japan,

and then that soon was taken up by a lot of especially high income countries, mainly who had this sort of outrage about the vaccine, and the DTP became the DTAP for Acellular Pertussis, not a whole cell. So now it is the DTAP for Acellular Pertussis, not a whole cell. So now it is the DTAP, which remains to this day, the vaccine that you get. Now, in countries where the DTAP is in use,

we do see periodic resurgences of it. Prior to any like vaccine laws kind of breaking down, the great thing about this vaccine is it has fewer side effects. The downfall is that it doesn't last quite as long. So we still need to get boosters of it at least every 10 years, although for some people it could, that immune response could wane as fast as five years.

The older vaccine, stronger reaction lasted longer. This one, not so much a reaction, doesn't last quite as long as one of the downfalls of it. So we do see these epidemic cycles even before we start getting into vaccine laws and all that kind of stuff. I have treated pertussis in my career. Years and years ago, I saw cases of pertussis,

especially among adults who don't get their boosters very well. And then if you also take a population of adults who have maybe chronic lung disease So we have a lot of people who smoke in our area and have chronic lung disease. They're they're at higher risk, right? So what do you do with all this information? Freak out No panic no first of all

First of all, you know what vaccines you need. Kids get the DTAP at two, four, six months, between 15 and eight months, between four and six years, and between 11 and 12 years. That's the regular scheduled recommended vaccines. I would highly recommend, you know, discuss that with your provider, keep on schedule.

And by the way, at 11 and 12, it switched to the Tdap. The Dtap and the Tdap are the same in terms of what they vaccinate you against, but they're flipped because of amounts of stuff, because they're for kids and adults. But it's the same. They're protecting you against the same thing. Adults get the Tdap when they're pregnant,

so I got it both times around, between 27 and 36 weeks, and then every 10 years is the recommendation. If're not sure if you don't know it's okay to get it go please go discuss with your medical provider you got it when I was pregnant with Cooper great so you should be fine for now if someone gets pertussis we can generally treat them with azithromycin for the most part that is the that is the treatment for it azithromycin. For the most part, that is the treatment for it. Azithromycin is also known as? A-ZT.

No. Z-Pak. A Z-Pak, yes, a lot of people have heard of the Z-Pak. It's a very common antibiotic. Most of the time, a Z-Pak and we can treat pertussis. That's a good thing. Doesn't mean that it's not a big deal, but it is treatable.

If you're allergic to that, we can use Bactrim. So there's other options and there is prevention dosing If you know you've been exposed you can go in and get azithromycin preventative dosing to keep you from getting pertussis So there are ways to prevent it. There are ways to treat it all this being said we are not Having these outbreaks right now because of any new idiot policies. But this is the kind of thing, whooping cough, measles, these are the things we will see more of as vaccine mandates are weakened across different states and then maybe federally.

What you can do is make sure you're up to date on your vaccines, make sure anybody you're responsible for, if you're a guardian for anybody, that they're up to date on their vaccines. Encourage other people. I just this morning was encouraging someone, hey, if you haven't gotten your Tdap in 10 years, go get a Tdap. Local health departments, your local healthcare providers, pharmacies, a lot of people carry this vaccine. It's widely available.

For most of us, we can tolerate it just fine. It makes your arm a little sore and that's about it. Obviously, if you have concerns, if you're allergic, if you know any other, talk to a healthcare provider. But make sure that you are getting your vaccines. If you are sick and you're not getting better, please go seek treatment. And then healthcare providers, our job is to remember that whooping cough is still a

thing. It is not just an old timey disease. It is around now. We are seeing it now. And we will be seeing more of these as vaccine mandates are loosened. So you've got to keep that in your mind. Thank you so much for listening to our podcast. We hope you learned something today. And we want to thank the taxpayers for the use of their song, Medicines, as the intro and outro of our program.

And thanks to you for listening, my friend. That's gonna do it for us. Until next time, my name's Justin McElroy. I'm Sydney McElroy. And as always, don't drill a hole in your head. ["Five-Eleven Rose"] ["Five-Eleven Rose"] ["Five-Eleven Rose"] ["Five-Eleven Rose"] ["Five-Eleven Rose"]

["Five-Eleven Rose"] ["Five-Eleven Rose"] ["Five-Eleven Rose"] ["Five-Eleven Rose"] Alright! Yeah! Maximum Fun, a workaround network of artist-owned shows, supported directly by you.