Pertussis is back. Why is the „forgotten” disease attacking children again? Episode 117

Monika Rachtan
Hi, Monika Rachtan. I'd like to welcome you to another episode of Po Pierwsze Patient. Pertussis a term so forgotten that it would seem that such a disease no longer exists. And yet we are talking about whooping cough, a disease from which, according to the Ministry of Health, as many as 32,000 people in Poland fell ill in 2024. I am going to talk to my guest today, Professor Agnieszka Szuster-Ciesielska, about who this disease can be particularly dangerous for. A very warm welcome to you.

Prof. Agnieszka Szuster-Ciesielska
Good morning, madam, good morning to you.

Monika Rachtan
Professor, whooping cough, a disease that we would like to forget. Or it would seem that we have not talked about it so much in the media for a few years now, and yet last year there was a lot of information about cases, about waves of cases. The Ministry of Health figures I mentioned 32,000 incidences, but we're about to talk about whether they are accurate and overestimated. But perhaps to start with, for whom might this disease be particularly dangerous?

Prof. Agnieszka Szuster-Ciesielska
Pertussis is not a new disease. The bacterium that causes it. Bordetella pertussis, the pertussis bacillus, is ubiquitous. People are carriers of it and it spreads very quickly. It is a highly contagious disease. It turns out that one infected person can infect another 17 people and it is very easily transmitted by the droplet route because the bacterium is present in the secretions, so when it appears and it hits a susceptible population, susceptible in the sense of vaccinated or immunocompromised people and mainly children who have not yet been vaccinated it spreads very quickly and the underlying symptoms.

Monika Rachtan
Professor, excuse me, I will also ask about the spread of this disease. The spread, that is, if it's a droplet infection, let's say I'm ill and I go into a public place, for example my workplace, and I sneeze, then very quickly the bacteria spreads around the room. And, in fact, all the people around me, other workers, are at risk of contracting the disease, and if they are unvaccinated, there is practically a very high probability that they will become ill.

Prof. Agnieszka Szuster-Ciesielska
True, this is when there is a very high risk that you will become infected and ill. The symptoms are very characteristic of whooping cough. Anyway, whooping cough, pertussis is all about a cough that is very long, paroxysmal with wheezing and long lasting from a few weeks, even up to many months. It is very, very troublesome. Sometimes these attacks are so severe that, imagine, a broken rib could occur.

Monika Rachtan
Professor, but we associate coughing as such a protracted problem, an inconvenience during the day, that we have to go out when we are talking to someone, for example, when we start coughing in this way. But are there also some first symptoms that might indicate that we are just dealing with whooping cough? So not just a cough, but a fever, for example? Such symptoms typically cold, group symptoms. Here, should we actually associate pertussis only with coughing?

Prof. Agnieszka Szuster-Ciesielska
At first, the symptoms are not very characteristic. There are the so-called prodromal symptoms, which are typical of very many bacterial or viral infections, i.e. worse mood, raised temperature, lack of appetite, fatigue and only later does that characteristic cough for whooping cough start to appear.

Monika Rachtan
Professor, I was referring to the 2024 figures. The Ministry of Health states that there were 32,000 cases, but we know that, as in the COVID 19 pandemic, not everyone reported to a doctor, many people passed the disease, and even if they reported to a doctor, the doctor did not always order tests to identify infection with this bacteria. Please tell me, do we have any estimates? Do we have data that allow us to determine how many people could actually be ill with pertussis in 2024? Could these figures from the Ministry of Health be an underestimate of 50%, or is it a much higher figure.

Prof. Agnieszka Szuster-Ciesielska
In 2024? We are indeed talking about more than 32 000 infections. These were diseases, diagnosed cases, but we can indeed speak of a serious underestimation. Why? Because, in adults, this disease can run its course with very few or no symptoms. There are cases like this, and then the person does not realise that he or she has whooping cough, but spreads the bacteria and is an active carrier. And this is very dangerous. If the bacterium reaches susceptible people, children, they become symptomatically ill.

Monika Rachtan
At the beginning, I asked about those who are particularly at risk of contracting the disease, but I am also concerned precisely about the severe course of the disease, because you mentioned children who have not yet been vaccinated. What might the course of such an illness be like in a child who, for example, has not yet received the vaccination because of his or her age? Is this an illness that could prove fatal?

Prof. Agnieszka Szuster-Ciesielska
Unfortunately, yes. In severe cases, deaths occur with whooping cough infection. This cough in a child is very violent, paroxysmal, with wheezing, preventing proper breathing. And worst of all are the complications and such a severe course of this disease. Because there is respiratory failure, there can be sepsis, inflammation, severe exudative pneumonia, encephalitis. So these are all very serious complications. What I haven't said yet is that in the 24th year, this is the same year when there was just such a large outbreak of whooping cough. There was one fatal case just in an infant in Poland.

Monika Rachtan
And what are the projections for 2025? Are we already seeing a high incidence of pertussis this year as well? Can we forecast that in 2025, 26 this incidence will increase?

Prof. Agnieszka Szuster-Ciesielska
Pertussis appears in waves every 2 to 5 years. We have seen significant increases. And the year 24 was probably the year in which. In which there was this increase. About this current year these cases are slightly less. Also, this peak of the wave was indeed last year.

Monika Rachtan
Professor, I should now like to pass on to everyone here the very good news that we do, after all, have a vaccination calendar that allows us to effectively avoid disease and to protect ourselves against it, to guard against it. And yet there are many cases of disease. So what is the vaccination rate in our population? Because whooping cough vaccinations are the vaccinations that are described in the vaccination calendar as the mandatory ones, not the ones that we can choose, that we can opt for. Only the ones that should be given to us and for which we should not give the child. Parents can get a fine of 50,000 zloty. So what is the vaccination rate in our country?

Prof. Agnieszka Szuster-Ciesielska
It is indeed a vaccination cycle, so in order to obtain the highest level of protection, 4 vaccines are administered up to the age of 3, and then 2 more booster vaccinations at the ages of 6 and 14. These are included in the compulsory vaccination calendar. So indeed this obligation must be adhered to on pain of certain penalties. As you mentioned, the vaccination coverage is very good, in that it is over 93%, and therefore protective of the youngest population. It is much worse in older people, because the last vaccination is given at the age of 14. This is a cell-free vaccine. And then you have to update these vaccinations once every 10 years You should give this vaccine. Adults don't remember this, doctors don't remind them very often.

Monika Rachtan
Well, Professor, whose responsibility is it? Because 14, or 24, is a young person, probably starting their working life still studying. Who is thinking about vaccinations then? They think about seeing their primary care doctor, about prevention. But I already hope that we have an informed audience here who have heard, would like to protect themselves against whooping cough this year. That is to say, I understand that when we are 24 years old, we can go to our primary care doctor, because it is no longer appropriate to go to the paediatrician, and ask about this vaccination against whooping cough, sign up and whether the vaccination is paid for. What does it look like?

Prof. Agnieszka Szuster-Ciesielska
Then this vaccination is paid for. And that is the trouble, because firstly we don't remember, and secondly there is a paid vaccination, so you have to pay out of your own pocket for this vaccination.

Monika Rachtan
Sure, but then 24 and 34, another vaccine. In fact, every 10 years we should be vaccinated to maintain this immunity against bacteria.

Prof. Agnieszka Szuster-Ciesielska
Yes, because immunity after vaccination, and especially after the acellular vaccine, because this is the only vaccine offered to adults. It lasts for a much shorter period of time, and this means that a person can become infected with whooping cough, they can get over it, and at best, if they don't get sick, they will be a carrier and infect.

Monika Rachtan
There are many vaccines available on the market. Some are dedicated to adults, as you mentioned, others are dedicated to children. Can we sort out which vaccinations the vaccination calendar provides for whom. We still have pregnant women who are also vaccinated against whooping cough, so if we could explain to our listeners and viewers which vaccines are dedicated to whom.

Prof. Agnieszka Szuster-Ciesielska
The current vaccines that are dedicated to children and adults are multivalent, combination vaccines, specifically trivalent against tetanus, pertussis and diphtheria. There is no vaccine that addresses only pertussis. Here there is a fundamental difference between these vaccines that are addressed to children. This is because the vaccination programme recommends that children receive 4 doses of the whole-cell vaccine by the age of 3, and then two booster doses at 6 and 14 years of age, and for adults, these are the cellular vaccines. There is a fundamental difference between these vaccines, in that acellular vaccines contain 2 to 5 antigens, whereas full cell vaccines contain up to 3,000 antigens. These are killed bacteria that cause such a very broad response and they have a number of other advantages and advantages over acellular vaccines.

Monika Rachtan
That is, this first contact with the vaccine with the bacteria. Here is this immune system response is much better with these multicellular vaccines, because of the greater accumulation of antigens, right?

Prof. Agnieszka Szuster-Ciesielska
Firstly, the sheer number of these 3000 antigens indicates that we will have a broader response. This is particularly important in the context of just vaccinating small children who receive from their mothers, newborn babies receive antibodies against whooping cough from their mothers, but pregnant women are vaccinated with an acellular vaccine, so such an infant will receive antibodies from the mother has, these are antibodies directed against only a few antigens and in a situation where the mother's antibodies will neutralise these vaccine antigens. If it were an acellular vaccine, then this immunity would be weakened. I will also mention another very important phenomenon. This is what is known as immunological stigmatisation or imprinting, which shows that the most effective response occurs when we are first confronted with an antigen. I will use the example of the game to talk about this, because there are people who say, for example, that I do not get the flu, because it really depends on which strain of flu, which strain of bacteria in the vaccine we get first. It sort of marks our response for the future. That is why the type of pertussis vaccine a child receives at birth is so important.

Monika Rachtan
The vaccination calendar, as you mentioned, recommends that whole-cell vaccines should be used initially in these first doses. Only later do doctors and parents turn to cell-free vaccines. But is what the vaccination calendar recommends in line with observations, with scientific studies? And how does this translate into practice? Do parents actually also in these first doses and doctors use the vaccines that the vaccination calendar indicates. But do they deviate from the recommendations and reach for those vaccines that do not guarantee the full immunity that the full-cell vaccines guarantee.

Prof. Agnieszka Szuster-Ciesielska
Of course, in 1997, the acellular vaccine was first introduced and the initial studies showed that this vaccine was much better received by both parents and doctors because, as the studies showed, it had a lower reactogenicity than the whole-cell vaccine, reactogenicity, that is, side effects, adverse effects, that is, what most diseases are.

Monika Rachtan
What parents fear most in terms of vaccination.

Prof. Agnieszka Szuster-Ciesielska
Which are very important, because they cause stress to the child, stress to the parent and all sorts of side effects. It can be inconsolable crying, redness, swelling at the injection site that stress the child and the parents. But however, the latest research, which was carried out in 2021, shows that when comparing the side effects of both acellular and whole-cell vaccines, there is really very little difference. Statistically insignificant in terms of the incidence of adverse reactions, and serious adverse reactions with both vaccines are extremely rare. About a frequency of one case per million doses given. So this is indeed very few, very rare serious adverse reactions. Furthermore, doctors suggest that parents give acellular vaccines for this very reason. An additional argument is that acellular vaccines come as highly conjugated, highly conjugated e.g. 5-in-one, 6-in-one.

Monika Rachtan
I would also like to ask on behalf of parents, including those at the beginning of their journey, that when these first vaccinations are offered to parents, there is a package, a so-called one-stroke package, which means that the child will be in less pain, that it will be quicker and that there will be less stress if vaccinations are administered in a single injection, to use the language of parents. However, there hides a vaccine which, again, is not the one indicated by the vaccination calendar, that is, not the full-cell vaccine, but a vaccine with precisely lower efficacy.

Prof. Agnieszka Szuster-Ciesielska
This is true. In those vaccines that are given they are highly combined, that is 5 in one, 6 in one. Here it is the acellular part against pertussis that is included in the vaccines. So a child at the beginning of his or her life, if the parents decide and listen to the doctors, receives a vaccine which, as a result, will not provide such effective protection in the future, in the sense that the child may later be a carrier of the bacteria and spread the bacteria. Because, as I said, it is very important what antigen the child's body receives first.

Monika Rachtan
But it seems to me that this knowledge of vaccination, especially against whooping cough, where these discussions concerning NOPs, adverse reactions, they have been present both in the media and on the Internet for many years. And if doctors are aware, they should be aware that by offering a 6-in-1, 5-in-1 vaccination, they are at the same time offering the child a vaccine which is less effective, which gives a lower immune response. What is the reason for this? Why has this happened since that 97th year, practically 28 years have passed. Scientific studies show that there is little difference between vaccines. As far as the occurrence of NOPs is concerned, why are there still babies who are at risk from whooping cough in such a way that exposure to the bacteria can cause death, as we encountered in 2024. Why are doctors recommending vaccines that are not whole-cell?

Prof. Agnieszka Szuster-Ciesielska
This, it seems to me, is precisely the aftermath of those studies that took place much earlier, where they pointed to the cell-free vaccine as the one that gives a lower intensity, lower frequency of adverse reactions. On the other hand, it would be worthwhile for doctors to update their knowledge, which shows through their latest study in 2021 that the reactogenicity of the two vaccines is comparable, and the paper that turned out this year in Nature Communications, which shows that it is after the whole-cell vaccine that this immunity and memory of vaccination lasts even for decades. Perhaps it would still be worthwhile here to compare for the knowledge of parents what are the specific differences between both types of vaccination in the context of the immune system? Well, the content itself. The difference in antigens alone makes the response after vaccination with the full-cell vaccine much more extensive. It lasts longer. Why? Because after vaccination with a cellular vaccine. Here it is estimated that this immunity can last about 5 years, some say shorter, even a year or two. Whereas after a whole-cell vaccine, just this latest work from 2020 shows that this immunity can last up to decades 30 to 50 years.

Prof. Agnieszka Szuster-Ciesielska
The type of specific immune response that both types of vaccine induce is important. For the reason that the whole-cell vaccine organises, it induces a response in the lung area of the lower respiratory tract, which favours the removal of bacteria much faster than is the case with the acellular vaccine. In addition, 2 types of antibodies are induced. IgG4 class antibodies. One and the other vaccine induces them. And very well, because there are antibodies that neutralise the toxin. But unlike the acellular vaccine, the full-cell vaccine induces IgG1 class antibodies, and these are the antibodies that enhance the cellular response. What is this cellular response needed for? And it is precisely to eradicate bacteria. That's why people who as children received a full-cell vaccine in their primary vaccination, already as adults, if they receive the vaccines, the acellular vaccine, they still present a very good immune response profile and immune memory. Even if they become infected with whooping cough, because as I mentioned, this bacterium is ubiquitous, they will not, there will be no symptoms of the disease, and more importantly, these individuals will not be carriers. And this is important, because those people who have gone through the scenario of vaccination with the vaccine, the acellular vaccine in childhood, are more likely to be infected more often, as shown, for example, in California in 2014, where children vaccinated with the acellular vaccine became infected with whooping cough up to twice a year and were carriers of the bacterium.

Monika Rachtan
That is to say, we can say in this simple way that the whole-cell vaccine protects us for many years and actually also reinforces the effectiveness of the cell-free vaccine, which is given as a booster dose. However, when we decide or choose to have our child vaccinated with a cellular vaccine, here we have no guarantee of a lasting immune response. On the other hand, we also expose the child to these frequent infections. Are they also always symptomatic? Or can the child be asymptomatic?

Prof. Agnieszka Szuster-Ciesielska
I wanted to articulate this here, so that it is understood. Sure, both vaccines are effective, both vaccines protect against symptoms, against the development of the disease, against severe complications of whooping cough. This is true, but this benefit, the greater popularity of the acellular vaccine is actually apparent, because the protection itself is apparent. This is because what counts are the consequences of being vaccinated in the future and what the full-cell vaccine gives us, even though it is less popular nowadays precisely because of this, perhaps not refreshed and not fully up-to-date, knowledge of doctors than the acellular vaccine.

Monika Rachtan
You deal with disinformation regarding health. You make a lot of posts on the Internet, on social media, and you are also trying to refute fake news, such as the spread of false information, disinformation, fake news, but also such as the anti-vaccination movements which, unfortunately, are very popular in Poland, and we should not be proud of that. How they contribute to parents doubting the effectiveness of vaccinations, to parents opting out of vaccinations, to parents not reaching for effective vaccines but, let us say, for the easier ones. And that it is also so hard to explain to them in general what the effectiveness of vaccination is. Why has this trust in vaccination by authorities such as social media and the internet been shaken?

Prof. Agnieszka Szuster-Ciesielska
Of course, the anti-vaccine movements and the leaders of these movements are very well established not only in Poland, also in the United States, but particularly intensified during the pandemic and the introduction of vaccines on the new mRNA-based vaccine platform. Initially, these movements were directed towards COVID 19 vaccines, but later this spread to all other vaccines, claiming that children are receiving too many vaccinations compared with previous years and, in addition, in Poland, many vaccines are obligatory and this decision should be left to parents. I am very much against such arguments of anti-vaccination groups because, unfortunately, compared to countries where vaccination is voluntary, such as Sweden or Finland, for example, the level of vaccination is very high. And now you can ask yourself why it is that vaccination is optional, And yet this level of vaccination is very high. Because it depends on the awareness and the maturity and attitude of parents, who know how vaccinations are necessary and how to fight infectious diseases, which is why they vaccinate their children. We do not have this awareness. This is why I regret the fact that the subject of health education, which, in my opinion, is truly a revolutionary subject because it touches on so many different issues, is not compulsory. It should be a compulsory subject. It should also have included hours in which children were educated on how to combat fake news, what disinformation is, because nowadays, it comes from everywhere on social media. There isn't a child who doesn't know what Twitter is, what X platform is, what TikTok is, and they get their knowledge from there.

Monika Rachtan
Do you happen to view these posts on TikTok, for example, on X?

Prof. Agnieszka Szuster-Ciesielska
I don't browse on TikTok. On the other hand, I browse on Platform X and Facebook, so Platform X in particular is full, filled with misinformation of all kinds.

Monika Rachtan
Well, that's right, but it's also about such a young person I don't even. Not young. Every one of us, when we read information like this, whether it's about vaccinations, or other areas related to health, but even other areas related to life. And when now more and more people who are involved in spreading fake news, misinformation. They write this information in such a way that it's really laid out beautifully, it's backed up by sources that don't exist. Yes, there is an asterisk or a link so you can look it up for yourself somewhere. A more inquisitive person will look, check, but most people will look at the text, look well who's name is it? The doctor has written a long text and supported it with a source, so it seems credible. Unfortunately, many people do not check whether someone is a scientist or a doctor, because they have no factual knowledge and no verifiable authorities. They simply believe. They follow the fake news blindly. And what you said, he forgoes vaccinations, he forgoes preventive examinations, he follows strange diets from the Internet, all of which affect our health, and he does not really think about the fact that he is also passing it on. That is to say, he himself spreads misinformation, that is to say, he spreads and is responsible for more people giving up healthy lifestyles, healthy behaviours. And here what you said I think since June, when it was known that health education was not going to be a compulsory subject, every guest who sat on that couch in that programme said they regretted it. It's been more than 15 episodes now where every time we lament that the Ministry of Education has decided to take such a step as just introducing health education, which is voluntary. I feel that parents do not understand how important it is for the life and health of their children to make health education a compulsory subject. For me, I don't know how you think, but I think it is more important to know how to take care of your health than what year the Battle of Cedynia was.

Prof. Agnieszka Szuster-Ciesielska
This is true, but it should be noted here that the anti-vaccine side is extremely active and sometimes even aggressive in convincing parents. It slips them ready-made statements that only need to be signed, handed over. These statements were distributed in schools. Unfortunately, but also there were words of warning directed from pulpits. So all this combined resulted in parents, who are perhaps more susceptible to all sorts of conspiracy theories, just trusting such simple, short messages that undermined the desirability of introducing health education as a compulsory subject.

Monika Rachtan
You mentioned NOPs, i.e. adverse reactions to vaccination, at the beginning. Can we summarise this knowledge on NOPs. We have studies from 2021, 2022 and 2023 on adverse reactions. We have the ones you mentioned from the year 97, but let us not deceive ourselves, this knowledge was completely different twenty-some years ago. Can we today compare cell-free vaccines, whole-cell vaccines and tell parents that NOPs are something that happens extremely rarely, probably with both vaccines.

Prof. Agnieszka Szuster-Ciesielska
As I said, after either vaccine, these serious NOPs are extremely rare. It is only one case in a million doses administered. On the other hand, I would very much ask parents to trust this latest knowledge, because it is only the work of this year that shows years of observation. It took decades of observation to establish clearly which of these vaccines is more effective, which gives longer protection. This is also important from the point of view of public health, because if we use vaccines which are effective, which have long-lasting protection, then there is a reduction in the number of hospital admissions, a reduction in the number of serious complications in children, a reduction in parental absenteeism, and, in other words, this has not only an individual dimension, but also a population, social and economic dimension.

Monika Rachtan
Well, precisely, because these consequences associated with higher morbidity simply because we get infected more easily, these are absences from work. These are absences from school, these are the need to pay health benefits, and we have to take all this into account when making decisions about our health, that is, our vaccinations.

Prof. Agnieszka Szuster-Ciesielska
It is true, pertussis vaccination is extremely important, because it is a disease that spreads extremely quickly. And as I mentioned earlier, the consequences, the complications, especially in young children, can be very serious, even leading to disability.

Monika Rachtan
You said about the studies that summarise the effectiveness of pertussis vaccination. We also know the vaccination calendar guidelines, and the World Health Organisation. What are these recommendations for pertussis vaccination?

Prof. Agnieszka Szuster-Ciesielska
As early as 2015, a few years ago, the World Health Organisation was just pointing to whole-cell vaccines as being more effective, giving longer protection, and they were just proposing a return to those vaccinations that we all went through in the 1960s. I myself was vaccinated with a whole-cell vaccine, I don't remember. On the part of my parents, that I somehow suffered from any serious. Adverse reactions. But in fact maybe this is anecdotal evidence. However, I have had several interactions with people who were sick with whooping cough as an adult, and yet I did not get sick. And this anecdotal evidence is confirmed by clinical studies and by numerous observational studies. What else could I add here? That since the acellular vaccine was introduced, which was 1997, we have an increasing population of those people who were vaccinated with the cell-free vaccine as children, so there is an increasing group of people who are susceptible to pertussis after many years.

Monika Rachtan
That is, what we have seen in 2024, This could be a consequence of just how this population of vaccinated people has changed. It could be a consequence of these people not having received the first dose of just the whole-cell vaccine.

Prof. Agnieszka Szuster-Ciesielska
This is what Nicolas Vangen, who concludes in his 2020 paper that the use of vaccination in childhood in the form of acellular, cell-free vaccines results in the very peaks of pertussis cases occurring from time to time, which completely look the same. Just as often as before the introduction of vaccination.

Monika Rachtan
One more very important issue, which is also a hot topic on social media, on the internet vaccination of pregnant women. Is the cell vaccine that is given to pregnant women safe? And should it be so widely recommended by gynaecologists? Does it actually give safety to a baby who is born and who is not yet vaccinated, waiting for its vaccination dose? Does it actually give any safety to the baby if the mother takes the vaccine during pregnancy?

Prof. Agnieszka Szuster-Ciesielska
The baby is most susceptible in the first few weeks of its life to these bacteria and goes through whooping cough very seriously, with a high rate of action, complications and the very severe ones I mentioned, such as pneumonia, apnoea, severe respiratory distress or sepsis. So the only thing we can do is to protect the baby, but precisely by vaccinating the mother. And here the doctors recommend that a woman should be vaccinated against whooping cough in every pregnancy, no matter how many years have passed since the last dose of vaccine, I get the vaccine then, and the coeliac vaccine so that the antibodies that the IgG class antibodies will produce reach the baby through the placenta and the baby is already born with a pool of maternal antibodies to protect it. But if we add here. If the child receives a vaccination scenario with a whole-cell vaccine, then here we are greatly enriching the arsenal of the immune response. Because the whole-cell vaccine has more than 3,000 different antigens that will not be neutralised by the mother's antibodies, so the child becomes more immune and builds a more effective immunity against the pertussis bacteria.

Monika Rachtan
And can we compare such a child more already an adolescent, an adult, who took full-cell vaccines as recommended in the vaccination calendar all doses were recommended, were full-cell doses. And it is the immunity of the young person who has received the cell-free vaccine, whether at the age of say 14, 16, 18 years of age this arsenal in the immune system, all these soldiers that protect us from getting sick. Are they equally armed?

Prof. Agnieszka Szuster-Ciesielska
Well, given the variety of antibodies that are produced, so surely this response after the cellular vaccine is poorer. But it is absolutely necessary here to confirm the efficacy of both vaccines against the disease symptomatically. On the other hand, when it comes to effectiveness in getting rid of bacteria, in cleansing the body of bacteria, the absolute leader here is the vaccine, the full-cell vaccine, so such a person, such a teenager or an adult, who was vaccinated with the full-cell vaccine in childhood. Even if he becomes infected with whooping cough as an adult, his body eliminates the bacteria from his respiratory tract much more quickly. This is because it has been so equipped from the start with high protection.

Monika Rachtan
I think that social media and the Internet are a good place to educate, to fight disinformation and fake news, and to talk about population immunity. Because it's also a very important concept and a very important term that affects all of us. And all of us, by deciding to vaccinate, responsibly take care of population immunity, that is, so that our society is protected against dangerous diseases, which pertussis undoubtedly is. But we are also healthy individuals who can be vaccinated. We are, in a way, responsible for the health of those people who cannot receive the vaccination for some reason, because such a group of people also exists. And it always comes to mind when I think of whooping cough. A story comes to mind that was told to me by a national consultant in paediatrics when two children met in the corridor of a clinic. A toddler who could not yet be vaccinated against whooping cough because he was simply too young and a preschool child whose parents had opted out of the whooping cough vaccination. These children met at the clinic in the corridor and one and the other went to the doctor's surgery. It turned out that the older child was ill with whooping cough. He got over this illness simply by taking medication and nothing terrible happened. On the other hand, this child, who was very small and did not have time to receive the vaccine, unfortunately died after contact with the older child. And I'm thinking here about responsibility and the fact that when we opt out of vaccinations or when we take them in a way that doesn't rely on the opinions of anti-vaccinationists, social media, we can do harm to ourselves, to our child, but also to society. And that I think is a very important thing to take into account when making such important decisions for the health of our children, for our health.

Prof. Agnieszka Szuster-Ciesielska
You have raised a very important issue here, because up to now, we have actually been talking about the benefits of vaccination on an individual level, but, after all, as a society we should be building permanent social immunity against infectious diseases. The best example of this is achieving permanent immunity to smallpox, which was eradicated or eliminated thanks to vaccination of the population. We no longer vaccinate against smallpox, I was vaccinated, you probably were not.

Monika Rachtan
I do not recall.

Prof. Agnieszka Szuster-Ciesielska
Certainly not because this disease was eradicated in 1980. I will also speak here about so-called cocoon vaccinations, because, indeed, if there is a group of people in our society, both adults and children, who, for various reasons, cannot be vaccinated, for example, children with immunodeficiencies who cannot hold live vaccines, that is, with viruses and bacteria that are live, only attenuated, and the only chance for them not to get sick is if everyone around them is vaccinated. As in this example you gave. If this older child had been vaccinated with the whole-cell vaccine, the infection of this younger child would probably not have happened.

Monika Rachtan
Dear all, 2024 has shown us that pertussis is a disease that is still present in our society. An effective defence against contracting pertussis is vaccination. A full-cell vaccination that gives protection as early as childhood. And this is something to bear in mind. You should also talk to your doctor about this, so if you have any doubts, would like to know more about vaccination, remember that your doctors are there for you. They will be happy to give you information, but I also invite you to your professor's social media, because there a lot of information about pertussis vaccination, but also a wide fight against misinformation is carried out there. Thank you very much to my, but above all to your guest, Professor Agnieszka Szuster-Ciesielska. Thank you very much Professor. And to you, as always, I wish you much health, especially during the cold season. This was the Po Pierwsze Pacjent (First Patient) programme, and my name is Monika Rachtan. Thank you very much.