Tuesday, April 5, 2011
William Schaffner, MD
As I was writing my last blog about the ongoing
pertussis outbreak in California, I couldn’t help
wondering why the Hispanic community is being so hard hit there. The peak
incidence is 547/100,000 among Hispanic infants younger than 6 months; nine of
the 10 infants who died from pertussis in California last year were Hispanic;
and 80% of hospitalized infants were Hispanic.
It’s tempting to assume that Hispanic infants aren’t getting
the recommended pertussis vaccine. But think about it. The peak incidence is
among those who haven’t had time to complete the primary vaccine series,
so it’s not their own immunization status that’s at issue.
We also know that Mexicans, the primary Hispanic group in California,
are generally very positive about vaccines and are vaccine compliant. In fact,
Mexico does a great job of vaccinating for pertussis.
One
hypothesis for the increased risk among Hispanic
infants is that they tend to live in large households, and the disease
is highly contagious among the unimmunized. This is a good hypothesis, but we
need to be careful of the conclusions we draw from it. Many of those who are
unimmunized fall into that category because they are too young (infants) or
because their immunity has waned (adolescents and adults).
And the real issue is that all adults, regardless of ethnicity, lose
their immunity over time and can spread the disease. The hard hit Hispanic
community might actually be a harbinger of even worse outbreaks to come if we
don’t face down the issue of waning immunity in all adults.
Make no mistake;
health care disparities continue and are a real
problem. But in this case, we need to look beyond the difference in
ethnicity-related outcomes and focus on the bigger need — making sure that
every child and every adult receives recommended vaccines.
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