Is Whooping Cough the “Canary in a Coal Mine” for Other Infectious Disease Outbreaks?

This is a highly detailed and realistic close-up of Bordetella pertussis, which causes whooping cough (pertussis), a highly contagious respiratory disease. (AI)

(Adobe Stock 958655470 by phurinee)

With the resurgence of measles and pertussis (whooping cough) in the US, experts are raising concerns about waning immunity and declining vaccination rates. Measles outbreaks in Texas and Kansas have reignited fears about preventable diseases making a comeback. Meanwhile, pertussis cases have surged to over 35,000 nationwide, leading health care professionals to question whether waning immunity, aging populations, and increased travel fuel this trend.

Michael Glazier, MD, cofounder and chief medical officer of Bluebird Kids Health, speaking with Infection Control Today^® (ICT^®) examines the differences between measles and pertussis immunity, the significance of booster shots compared to titer testing, and how social behaviors influence disease spread.

As respiratory infections rise, awareness, vaccination, and preventive strategies like masking can play a vital role in protecting vulnerable populations. This final installment of the interview with Glazier highlights the urgent need for proactive public health measures to prevent future outbreaks.

ICT: I'm considering the recent measles outbreak in Texas and Kansas.

Michael Glazier, MD: Boy, that's super transmissible.

ICT: Do you think measles is a canary in the coal mine to other infections? Does one tell you that others will be around as well?

MG: It's a good question, and I don't necessarily think so, given the difference between these two things. I feel that measles is more of a 2-dose vaccination series, and if everyone is vaccinated, we can eliminate it. We're going to address it. In contrast, Pertussis requires 5 or 6 doses, and immunity wanes over time. So, the main difference is between more permanent immunity and waning immunity. Both are impacted by nonvaccination, but a large part of the issue with pertussis is not just that I'm unvaccinated, but that over time, my antibody titers have decreased. As a generalist, I do think there is a difference there.

However, if there is a turning point where more people are resistant to vaccinations, I would view that as carrying the COVID-19 canary in the coal mine. But we aren't at that point right now. I'm not saying that I believe the 35,000 cases of pertussis are due to people not being vaccinated. I don't think that's the case because back in 2012, there were over 40,000 cases. Oh wow, you know, so this isn't unheard of. It's just very different from after the pandemic.

ICT: Do you think it's simply because the overall population is getting older? I mean, Generation X and the Boomers. We're all getting older.

MG: There's probably a contributing factor there. We're getting older, and we're living, right? Not only that, but this is a much bigger leap, but we're getting older and more socially old. We're doing more in the community at older ages than prior generations did. Even just taking the flying [conversation], like the marvel of airplane travel, is just incredible. But the ability to take something from New York and bring it to Ohio, like a brief flight is real. Each one has their [traveling] lifestyle.

ICT: If you could tell the world anything about pertussis or any of these respiratory diseases. What would you say?

MG: I would say that the number 1 most important thing is personal awareness that these are out here, and they do pose a risk to individuals, but also to individuals around them, that vaccination is the number one kind of gold standard to help prevent and or mitigate the effects and the vaccination. So as a parent, I always tell my patients, like I vaccinate my kids for themselves first, but also for my parents who are elderly, and also for the community and somewhat, that's probably the order in which I do it.

But people do need to know that when they make a decision about a vaccination, it's not just for that child; it's for everyone in their immediate circle. Yeah, and you know that it we talked, we talked about this a lot during the pandemic, like presentism, the act of going to work when you're, like, coughing up a lung, you know, pre-COVID-19 was maybe rewarded, but really shouldn't be like, like eight for effort. But if you're coughing all over the desk that someone else was sitting in an hour ago, chances are you're sharing more than they wanted you to. The strategic use of masks and the judicious use of time away. It's a bit hard to swallow when I say it always works if you're doing it for yourself and others, but when I say to do it for others, sometimes that message doesn't resonate.

ICT: Unfortunately, some people don't always think about or care about anyone else. They only care about themselves or their children, and that's about it. They don't care.

MG: It is, to a degree, a little bit of out of sight, out of mind. So, if somebody out there has grandkids who are just being born, if that's immediate front and center, they're probably going to check their pertussis vaccination. But if that's not on their radar, they won’t think twice, right? And I do think—I'd like to think—regular visits to the health care system are part of that responsibility. Providers need to remind patients that these resources exist. Recommendations change over time, like with the pneumococcal vaccine. Incidentally, I just got that 2 weeks ago because I’m the same age and talking about vaccines for myself.

ICT: Please telI our audience about Bluebird Kids Health.

MG: As a pediatrician who's worked in various settings, I often find that practices will accept Medicaid, but only to a certain extent because the reimbursement rates aren't always favorable.

For instance, a practice might say, "Hey, 10% of my patients are on Medicaid, so I'm a Medicaid provider," but they don't want that percentage to increase. This creates a two-tier system, which often leaves someone feeling overlooked.

We focus on providing exceptional care to everyone, but our focus is on Medicaid patients; we care for everyone, but we pay special attention to this group. We're establishing our clinics in areas that lack adequate care. We're identifying locations with, say, 4,000 children on Medicaid and only 1 doctor available.

For me, the key to a successful practice—I'm sure you'd agree—is to provide high-quality, evidence-based medicine. First and foremost, practices should be data-driven. However, ensuring a high-quality patient experience is equally vital, which has been lost in many health care institutions in recent years.

Quality care without a good patient experience doesn't work; I think many of us have felt that frustration. I might have received the medication I needed, but the process was exhausting. Therefore, what's just as vital as the medical care is that our patients feel seen, heard, and understood. That’s what truly excites me.