Whooping cough outbreak spreads to north with new case in town near Nahariya
Infectious disease expert posits that post-COVID vaccine fatigue and skepticism, as well as ‘immunological debt,’ are at play
Renee Ghert-Zand is the health reporter and a feature writer for The Times of Israel.
A pertussis outbreak in Jerusalem that began earlier this year has spread to the north of the country, with the Health Ministry announcing Thursday that a child in the western Galilee was found to have a confirmed case of the serious disease, commonly known as whooping cough.
The child developed symptoms several days ago and an epidemiological investigation confirmed the pertussis diagnosis, the ministry said. A report in Doctors Only, an online publication for Israeli healthcare professionals, stated that the child had not been vaccinated against the disease.
The investigation revealed that the child had been in close contact with 30 people, including at a summer camp in the off-the-grid ecological community of Klil, southeast of Nahariya, and a school on a nearby kibbutz. The local health department instructed the camp administration to contact all parents to give them information on whooping cough and the importance of vaccination, as well as to urge them to take their children to their family doctor for preventive antibiotic treatment.
The Health Ministry reported that its efforts to get the parents to follow up have not been completely fruitful. In response to the situation, a vaccination clinic for partially or completely unvaccinated children was open at the kibbutz school on Thursday morning. Parents who did not bring their children were urged to call the Health Ministry hotline to arrange for vaccinations.
The public became aware of the current whooping cough outbreak in early June when the Health Ministry announced that as of then, at least 215 cases had been reported since January, accounting for a 12-fold increase over the same period in 2022, when there were only 17 cases.
The vast majority of the cases this year have been in the central area of the country, mainly among ultra-Orthodox communities in Jerusalem where vaccination rates are lower than in other populations.
According to Israel Pediatrics Association chair Prof. Zachi Grossman, Haredi parents are not ideologically opposed to vaccinating but face other hurdles.
“[These neighborhoods] are characterized by inhabitants who live in large families where, as a result, contagion rates are often higher. These are not vaccine-resistant people by ideology. Rather, they have difficulty getting all their children to their well-baby clinic (Tipat Halav) appointments,” Grossman explained.
Following the death of a 10-week-old baby in Jerusalem and the severe illness of a four-month-old in Ashdod, both in June, the Health Ministry rolled out a plan to increase pertussis vaccine coverage.
The plan involved identifying unvaccinated or under-vaccinated children, disseminating notices about the need to vaccinate, keeping baby clinics open for longer hours, and reaching unvaccinated children through home visits and mobile units.
Pertussis is a highly contagious but preventable disease caused by bacteria that spreads easily through coughing and sneezing.
“Whooping cough spreads from person to person. It’s not released in the air. It’s a droplet infection, so you need to be face-to-face and in close contact. It’s unlike measles or other diseases that can spread over a long distance in a shared space,” explained Dr. Tal Brosh, head of the infectious diseases unit at Assuta Ashdod Hospital.
The disease is especially dangerous for babies, who can experience severe coughing and wheezing, among other symptoms such as vomiting, fever, and a runny nose. In the worst cases, apnea (pauses in breathing), cyanosis (turning blue), and death can occur.
One in five infants under two months with pertussis will require hospitalization on average, and one in 100 will die from complications of the disease caused by the highly infectious Bordetella pertussis bacteria. Treatment with antibiotics at the time of diagnosis does not significantly alter the course of the illness, hence the critical importance of preventative vaccination.
Protection against pertussis is given as part of the DTap or Tdap combination vaccines, both of which protect against pertussis, tetanus, and diphtheria. The vaccine schedule for infants and children involves six shots between the ages of two months and 13 years, given first initially in baby clinics and later in school.
Because infants cannot be vaccinated soon after birth, pregnant women are advised to get a pertussis vaccination in their third trimester — any time between week 27 and week 36.
Amid the outbreak, the Israeli Midwives Association urged expectant mothers to be vaccinated.
“It is critical to get the vaccine toward the end of pregnancy to protect the baby as it exits the womb and enters this world. The protection is provided by the antibodies against whooping cough that pass through the placenta and protect the baby for the first four months of its life,” the association explained in an official statement.
“The vaccination is safe for both mother and baby,” it said.
Although childhood pertussis vaccinations end at age 13, the Health Ministry advises adults to receive a pertussis booster shot after the age of 18 to maintain protection. This is especially critical for medical school students and those who work in healthcare settings.
Brosh pointed out that the reality is that most adults do not get pertussis boosters and that their protection against the disease relies on children receiving the prescribed schedule of shots.
“If the rate of childhood vaccination coverage goes down — even by a few percentages — then the entire population becomes more susceptible, and we can see real outbreaks,” he said.
He said he doubts that there is any direct connection between the whooping cough in the Haredi neighborhoods of Jerusalem, the new case in Klil, and a small number of cases in other parts of the country.
“These specific people from different parts of Israel aren’t necessarily coming into contact with one another. What we are seeing is a decrease in immunity to pertussis overall because of several things that have happened in the last few years as a result of the COVID pandemic,” Brosh said.
He attributed the whooping cough outbreak in part to the disruption of routine childhood vaccination schedules during the pandemic, as well as “vaccine fatigue” and “vaccine skepticism” that increased during that period.
“There’s something else at play, which is a concept called immunological debt,” Brosh said.
By this, he meant that over the two-to-three years of the pandemic, we had to adapt our lifestyles so that we practiced social distancing and other preventive measures in a bid to not become infected by COVID. The downside to this was that for a prolonged period, people were not exposed to the usual viruses and bacteria that help build up immune systems.
As a result, 2020 and 2021 saw almost zero transmission of respiratory viruses other than COVID, according to Brosh.
“Because of this, the population’s immunity dropped and there is a form of debt. After the pandemic, interpersonal contact returned to normal, and we saw increased transmission of viral and bacterial respiratory diseases. In the summer of 2021, we saw a large outbreak of respiratory syncytial virus (RSV), which is unheard of in the summer. And then we had a lot of influenza and strep throat,” Brosh noted.
“This pertussis outbreak is probably part of this. We are now paying the debt,” he said.
The Times of Israel Community.