It’s bacterial, sometimes deafening, and more infectious than the flu: whooping cough.
If it sounds like a throwback to a prewar novel, it may well be—whooping cough makes a cameo in Ulysses and in Anne of Green Gables. The earliest ‘confirmed’ epidemic was in Paris in 1578, and potential outbreaks date as far back as 1433 in Korea. But despite the availability of vaccines since the 1910s, the disease medically known as pertussis is alive and well in the twenty-first century. Why has it proven so hard to eradicate?
It’s a question tackled by the newest book from Oxford University Press’s series on Ecology and Evolution of Infectious Disease. Pertussis: Epidemiology, Immunology, and Evolution is the first major aggregation of interdisciplinary whooping-cough research in decades. Its editors are Samuel V. Scarpino, former SFI Omidyar Fellow now at Northeastern University, and Pejman Rohani of the University of Georgia.
Whooping cough appears on most Americans’ vaccination record in the form of DTaP, a combination vaccine for diphtheria, tetanus, and pertussis. But with the rise of the ‘anti-vaxxer’ movement, outbreaks have become more common, with infants most vulnerable.
“It’s still vastly under-appreciated what the risk is,” says Scarpino. A flu sufferer might infect two or three people on a daily basis. For pertussis, that number would be upwards of 14.
The book originated in “Re-imagining Pertussis,” a workshop at SFI in March 2016 for which Scarpino and Rohani acted as co-organizers alongside UGA’s Eric Harvill and Aaron King of the University of Michigan. They aimed for interdisciplinary cross-pollination, to gather information and to dissect some of the ‘myths’ in circulation, even among the scientific and medical communities.
“There are narratives about pertussis that are routinely described but not supported by firm evidence,” says Rohani. One such narrative holds that the introduction of the pertussis vaccine had no effect on how often a major epidemic occurred. Looking at data from a large number of countries reveals that this is simply not the case.
“Perhaps it’s surprising that there are so many competing narratives about pertussis, but perhaps it’s also not, given that there hasn’t been a synthesis of this scale in twenty or thirty years,” says Scarpino. “That’s one of the special things about the Institute. It’s a safe spot to convene a workshop and produce this book with a lot of people who disagree with each other, who have debated each other in the literature for a long time.”
With this book, they hope to push the field forward. Adds Rohani, “We need to find explanations that are consistent with all available data. Any explanation that’s obviously contradictory to what we see in some other setting raises more questions than answers.”