Whooping Cough Outbreak in North Idaho: What Can We Do Given Low Vaccination Rates?

Kootenai County in northern Idaho is experiencing a whooping cough outbreak, with 19 cases in the first four months of the year alone (compared to nine cases in all of 2021-23).

We shouldn't be surprised.

Idaho has the lowest vaccination rates in the nation, according to the latest numbers from the Centers for Disease Control and Prevention.

Idaho's vaccination rate for five doses of DTaP, used to prevent diphtheria, tetanus and pertussis (or whooping cough), was just 81%, the lowest rate in the country.

The national average rate is 92.2%, according to the CDC, based on numbers from the 2022-23 school year, the most recent year available.

Idaho also has the lowest vaccination rate for:

Idaho has some of the most lenient exemptions in the country, resulting in the highest exemption rate in the country at 12.1%. Idaho is one of only 10 states in the country with an exemption rate of more than 5%.

Idaho law allows parents to exempt their children from vaccination for almost any reason, not just medical or religious reasons, but also simply personal beliefs.

This lax exemption has led some people to move to Idaho, as documented in a 2020 Idaho Statesman story about vaccine “refugees” from California.

Come to Idaho to learn about vaccination laws. Stay for the illnesses.

The CDC reported that Idaho's exemption rate increased 2.3 percentage points compared to the 2021-22 school year.

We're going in the wrong direction.

According to the Panhandle Health District, which covers five counties in northern Idaho, most cases in Kootenai County are people ages 18 and younger.

Pertussis can cause serious illness in people of all ages, but is most dangerous for babies, according to a county news release.

About one in eight children with whooping cough develops pneumonia. About one in 100 infected infants suffers convulsions, and in rare cases, whooping cough can be fatal, especially in infants younger than 1 year.

According to the health district, many infants are infected by older siblings, parents or other caregivers who may not know they have whooping cough because the initial symptoms are similar to a cold.

Vaccine disinformation

Dr. David Pate, retired CEO of St. Luke's, said he is concerned about declining vaccination rates in Idaho, especially given recent outbreaks of vaccine-preventable diseases such as whooping cough and measles.

“I'm concerned about the low vaccination rates, both here in Idaho and across our country and even in many places around the world,” he said in a telephone interview. “The anti-vaccine movement has, unfortunately, really made a lot of progress.”

He blames doctors and others who have spread misinformation about vaccines and cast doubt on the safety and effectiveness of vaccines, particularly in the wake of unwarranted attacks on the COVID-19 vaccines.

These professionals have created a class of “vaccine hesitant” people who may not be as vehemently anti-vaccine but who are staying away from vaccinations because of the doubts that have been sown.

“For heaven's sake, if there are things we can do to prevent our children from dying or becoming seriously ill, why wouldn't we do that?” Pate said. “And the reason for that is because we have people out there who would benefit financially from spreading nonsense about vaccines and scaring people.”

Part of the struggle is that many people today have never seen a case of mumps, measles, rubella, diphtheria, whooping cough or polio and do not know how serious and dangerous these diseases can be.

Return of illnesses

Pate warns of the dangers of growing anti-science sentiment and emphasizes the historic importance of vaccines in preventing deadly childhood diseases.

He cited the recent case of an unvaccinated young man in New York who was paralyzed after contracting polio from an unvaccinated international traveler, the first known polio case in the United States in nearly a decade and the first in New York since 1990 .

Pate highlights the need for vaccines to maintain herd immunity to protect vulnerable populations such as infants, the elderly and those with weakened immune systems.

Pate said no medical procedure is without risk, but those risks must be weighed against the risks of the diseases they prevent.

He gave the example of a medical emergency at your home and the need to be hospitalized. Yes, there is a risk of getting into a car accident on the way to the hospital, but that doesn't mean you shouldn't use a car to get to the hospital and get help.

Chemotherapy and surgery carry risks and side effects, but you should take these steps often to prevent yourself from dying of cancer.

Overall, Pate said he advocates for a more compassionate approach to vaccine hesitancy and recognizes that many people have been misled by misinformation.

He told me a story he told on a recent episode of Idaho Matters on Boise State Public Radio about how he was raised by anti-vaccine parents, approached by a woman who was anti-vaccine and raised her children without vaccinations. She told him that she had been listening to Pate on the radio for the past four years and that she had decided to get her and her family vaccinated because he provided factual information without judgment.

Now we just have to do this a few thousand times.

Pate suggests strategies such as community outreach campaigns and personal statements from parents who regret not vaccinating their children as effective ways to combat vaccine hesitancy and protect public health.

Sound the alarm

I've been thinking about the Sound the Alarm campaign, in which the American Red Cross partners with local fire departments to distribute free smoke alarms that target neighborhoods where home fires are more common or at greater risk.

I have worked in other locations where the fire department and Red Cross covered a neighborhood shortly after a house fire in that neighborhood and realized that the situation would likely be similar with neighboring homes if the smoke detector was broken or non-existent. Where there is smoke, there is fire, so to speak.

The Sound the Alarm program has installed 2.5 million free smoke detectors in 1 million homes since October 2014, saving an estimated 2,000 lives.

Why not do the same for outbreaks and target affected counties, even school districts or census tracts, with educational campaigns and vaccination clinics where people live?

Katherine Hoyer, communications manager for the Panhandle Health District, said as soon as the district received reports of the first cases of this recent pertussis outbreak, district officials alerted health care partners that additional pertussis cases could potentially emerge, as well as a reminder that vaccinations are needed are the best protection against serious illnesses. They also contacted local schools and daycare centers to provide advice and resources.

That's a good start, but we should do more to ensure these small outbreaks don't become epidemics.

“The more opportunities we have to get these messages out, the better,” Pate said. “It is the people spreading the disinformation that we need to get angry about and hold accountable, not the people who have been deceived.”

Anna Harden

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