Как родители могут победить коклюш

Чтобы оправдать необходимость широкого охвата вакцинами как единственного средства защиты детей от коклюша, нам говорят, что матери не передают иммунитет своим детям. На фоне роста случаев смертей от коклюша у детей в возрасте до года (в группе, где ранее дети получали природный иммунитет от родителей) особенно интересны исследования, показывающие, что матери через плаценту могут передавать и передают иммунитет, который защищает ребенка по крайней мере до 3 месяцев1,2. И этот факт служит одним из доводов для очередного пересмотра идеи вакцинации беременных в последнем триместре3.

Другим популярным заблуждением, распространяемым медиками, является идея, что грудное молоко не дает защиты от коклюша. Хотя эта тема сейчас не привлекает потока средств на изучение вопроса, в ранних исследованиях можно найти свидетельства того, что молозиво и грудное молоко содержат антитела IgG и IgA, специфичные к четырем видам микроорганизмов: возбудителю коклюша, гемофильной инфекции типа В, пневмококку и менингококкам, для каждого из которых существует вакцина: противококлюшная, Hib, превнар и различные типы вакцин от менингита, самая последняя из которых MeNZB4,5,6.

Даже у тех матерей, кто не может передать своим детям специфические антитела, грудное молоко содержит множество других антибактериальных соединений, которые обеспечивают детям существенную поддержку иммунитета7.

Похоже, что матери, привитые в детстве от коклюша, могут столкнуться с той же проблемой, что и привитые от кори матери в 1990-х годах, потерявшие возможность передавать своим детям естественный иммунитет, как это делали их собственные переболевшие в детстве матери8,9,10. Это может объяснить, почему все больше малышей умирает от коклюша. Повезло тем матерям, которые были вакцинированы, но все равно переболели коклюшем в детстве (как наши дети) или позже. У них куда больше шансов передать своим детям достаточный иммунитет, если только они будут кормить грудью.

Врачи начали подумывать о вакцинации беременных от коклюша в третьем триместре еще в 1996 году. Но вакцинация беременных в третьем триместре связана со значительными медицинскими и законодательными проблемами.

Госпитализируемость из-за осложнений от коклюша у полинезийцев и маори выше, чем у выходцев из Европы, точно так же, как и от пневмонии, кори, менингита и серьезных хронических болезней12. Именно этим группам нужно больше действенной помощи, нежели предоставляется сейчас.

Без лишней огласки медики, похоже, недавно совершили резкий поворот в методах предотвращения распространения коклюша. В 2004 году Консультативный центр иммунизации признал, что вакцинированные дети тоже болеют коклюшем. До этого непривитые дети не допускались в школы на протяжении всей вспышки коклюша, как бы долго она ни длилась. Между тем привитые и кашляющие с диагнозом "что-то другое" оставались в классах. Теперь привитые дети с диагнозом "коклюш" отсылаются домой, но им позволяют вернуться в классы после пяти дней приема антибиотиков или через три недели после того, как начался кашель13. А д-р Маргарит Долтон из Консультативного центра говорит, что вакцина эта "не из лучших"14.

Итак, что же делать, если вы или ваш ребенок заболели коклюшем? Вы можете использовать традиционный медицинский подход — антибиотик эритромицин, но по своему опыту я знаю, что от этого у многих детей возникают проблемы с пищеварением и они, принимая антибиотики, чувствуют себя хуже, чем кашляя. И нигде мне не удалось найти убедительных научных доказательств того, что пять дней курса антибиотика или три недели пребывания дома после начала кашля гарантируют нераспространение коклюша дальше. Ведь другие члены семьи не сидят на карантине, а приходят и уходят.

Прием антибиотиков не помогает, а порой даже и вызывает осложнения. В трех исследованиях было показано, что антибиотики удлиняют период манифестации симптомов15,16,17. В исследованиях 2003 и 1992 годов было упомянуто, что при лечении детей антибиотиками период кашля удлиняется по сравнению с отсутствием лечения антибиотиками. Они объясняли это так:

Лечение антибиотиками — это признак более тяжелого течения болезни.

Меня это вовсе не убеждает, поскольку я видела детей с легкими случаями болезни, у которых в течение 24 часов после начала приема антибиотика кашель ухудшался. Полагаю, тут работает совсем иной механизм, что указывает на две связанные с этим проблемы.

Коклюш — это токсиномедиируемая болезнь, что означает, что симптомы, которые мы наблюдаем, частично вызваны токсином, который производят бактерии, прилипшие к ворсинкам в бронхах. Токсины срезают эти бронхиальные ворсинки. В норме слизь циркулирует в легких и бронхах и удаляется из бронхов этими ресничками, которые срезаются токсином, далее эта слизь проглатывается и поступает в желудок, где имеющаяся в нем кислота убивает потенциально опасные бактерии. Эта постоянная циркуляция слизи с удалением из легких важна для поддержания слизистых легких в здоровом состоянии и предотвращения размножения бактерий и возникновения инфекций.

По мере роста бактерий ворсинки в бронхах постепенно срезаются, слизь из легких начинает скапливаться в нижних отделах бронхов, и тут появляется проблема, поскольку там меньше ворсинок, и они не справляются с выталкиванием слизи наверх. Слизь начинает скапливаться внизу и мешать дыханию, поэтому ребенок начинает кашлять, чтобы удалить слизь. По мере того, как отмирает все больше волосков, слизи скапливается все больше, и кашель усиливается, поскольку организм пытается удалить избыток слизи и обновить ее в легких. Коклюшный токсин попутно раздражает бронхи и увеличивает выработку слизи и ее густоту.

Также этот токсин коклюшных бактерий преодолевает барьер слизистых оболочек и в организме нейтрализуется двумя способами. Во-первых, клетками Купфера в печени, поглощающими эндотоксин, и, во-вторых, антителами в крови.

При коклюше используют антибиотик эритромицин, который без разбора убивает и кишечную микрофлору, и бактерии, производящие токсины. Далее в книге вы встретите упоминание об эндотоксемии от кишечной бактерии E. coli18. В медицинской литературе хорошо известно, что если вы попытаетесь лечить инфекцию E. coli с помощью антибиотиков, то будет только хуже, поскольку при отмирании бактерий их оболочки (представляющие собой токсин) становятся источником курлина, он же эндотоксин, от которого печень должна усиленно избавляться. Такая эндотоксемия вызывается не кишечной палочкой с аберрантным геном, но усиленным выбросом токсина из кишечника в кровь19.

Если вы дадите антибиотик ребенку с достаточным количеством грамотрицательных бактерий в кишечной флоре, организм которого в данный момент занят переработкой коклюшного токсина печенью и антителами, это вызовет массовую гибель бактерий20. Одновременно погибнут не только E. coli в кишечнике, но и другие грамотрицательные бактерии. И эти другие бактерии высвободят свои токсины в организм, таким образом еще более усложняя работу печени и антител крови. Я убеждена, что эта тотальная гибель бактерий и вызывает дополнительную нагрузку на организм при приеме эритромицина или зитромакса, что приводит к ухудшению состояния больного коклюшем.

Итак, что же делать?

Высокие дозы витамина С (аскорбата натрия) были рекомендованы многими докторами прошлого, даже одним японским врачом21,22. Поиском в Pubmed можно найти немало данных по успешному использованию витамина С в лечении эндотоксемии, вызванной многими типами грамотрицательных бактерий23.

Врачебный бойкот аскорбата натрия для нейтрализации токсинов подобен игнорированию ими до недавнего времени витамина А для уменьшения осложнений и количества смертей от кори и других вирусных заболеваний, при которых потребность организма в витамине А увеличивается.

Также медиками игнорируются исследования, показывающие огромную важность селена для борьбы со всеми вирусными инфекциями, особенно с гриппом, гепатитом В, вирусом Коксаки, хантавирусом, энтеровирусами и полиовирусами, ВИЧ и ревматоидным артритом. Похоже, что фермеры, добавляющие селен в корм животным, знают о его действии больше, чем многие врачи. Недавняя газетная статья повествует о том, что не было сделано никаких попыток увеличить потребление селена новозеландцами, поскольку Университет Отаго сделал удивительное заявление о том, что при нынешнем положении нет никаких последствий для здоровья из-за низкого потребления селена и что мы якобы приспособились к этому24. При этом забавно, что страна занимает ведущие места в мире по заболеваемости острыми и хроническими болезнями, характерными для людей с дефицитом селена в пище.

Впервые мы встретились с упоминанием об использовании витамина С для лечения коклюша в медицинской литературе при довольно необычных обстоятельствах. Мы кое-что об этом слышали, но не имели никакого представления о дозировке, потому я давала витамин своим кашляющим детям наугад. Как-то утром один американский доктор позвонил мне именно в тот момент, когда я пыталась помочь своему болеющему младшему сыну натянуть футболку с длинными рукавами. Пытаясь просунуть руки в рукава, Дэвид начал кашлять. Врач узнал типичный лающий кашель и спросил меня, как я лечу ребенка. Когда я ему ответила, он сказал, что я даю слишком малую дозу витамина С. Он прислал мне несколько статей из медицинских журналов об использовании витамина С при токсиномедиируемых болезнях.

После того как я увеличила индивидуальные дозы до нужного уровня для каждого ребенка, я увидела радикальное улучшение. Для младшего, у которого иммунная система была другой, чем у старшего (кашель которого был без репризов), потребовалась бóльшая доза на килограмм веса, чем для старшего.

Чем выше количество токсина, тем выше требуемая доза для его нейтрализации. Заметное улучшение кашля наступает примерно через 12 часов, но для выведения токсинов из тела требуется 48 часов. Симптомы болезни заметно уменьшились, а у младшего ребенка пропала краснота глазных яблок, связанная с сильным кашлем. Когда у обоих сыновей случилась диарея, то я уменьшила дозу до стабильного уровня, разного для каждого ребенка. По мере улучшения требовалось и дальше уменьшать дозу, потому я повесила график приема аскорбата натрия на холодильник для того чтобы запомнить, кому из них я сколько давала.

По ссылкам в статьях, присланных американским врачом, я нашла другие статьи о лечении витамином С любых токсиномедиируемых заболеваний, а также сугубо медицинские книги с огромной доказательной базой. Я была удивлена тем, сколько собрано информации по этому вопросу, а еще больше тем, с каким пренебрежением она отвергается. Если вспомнить, что нет дыма без огня, то тут был налицо пожар катастрофических масштабов. О том, как действует витамин С и о его применении недавно были изданы еще две книги, но наилучшей и самой современной с медицинской точки зрения книгой является трехтомник профессора Алана Б. Клеметсона, опубликованный издательством "Си-Ар-Си Пресс" в 1989 году25,26,27. Подобно всем медицинским книгам, она очень дорогая и никогда больше не переиздавалась. Возможно, врачи полагают, что благодаря старым рассказам о цинге знают о витамине С все, и не понимают, что аскорбат натрия это не просто витамин. Это мощное вещество разностороннего действия участвует в очень многих процессах организма, а потому достойно куда более широкого применения в медицине.

Хочу вас предупредить на случай, если вы захотите использовать витамин С. Не ждите ничего другого, кроме того, что врач или больничный персонал объявят вас чудаком. Будьте готовы к тому, что кто-то может посчитать вас угрозой для ваших же детей. Вам могут даже говорить, что от этого у ребенка будут камни в почках или впоследствии разовьется цинга, что, конечно же, неправда.

Вероятно, из-за все увеличивающейся сопротивляемости микробов к антибиотикам и в отчаянии от мыслей о том, что скоро медики не смогут предложить ничего нового для антибактериальной терапии, растет число статей, посвященных применению витамина С и лечению других токсиномедиируемых заболеваний, в т. ч. по менингиту и сепсису, в медицинских журналах28,29,30. Если пройтись по всем приведенным ссылкам, то откроется огромный объем информации, детально показывающий, почему аскорбат натрия — логично обоснованное средство для лечения всех токсиномедиируемых заболеваний.

Если бы к информации по данному вопросу, опубликованной недавно в "Нью Зиленд медикэл джорнэл", отнеслись серьезно, то, возможно, некоторые из недавно нашумевших в прессе случаев менингита не закончились бы смертью или ампутацией31. Что они теряли?

Что касается коклюша, среди сознательно отказывающихся от прививок родителей в последние 20 лет информация об использовании витамина С при коклюше и других токсиномедиируемых болезнях распространилась как лесной пожар. Это высокоэффективное средство, в 75% случаев помогающее от кашля во всех возрастных группах, обычно даже за день приема. Дети при этом не теряют в весе, не отстают в развитии, не так сильно (если вообще) страдают от рвоты; их слизь не столь густа и у них нет таких проблем с дыханием, нет видимых припадков удушья. Единственной неприятностью остается кашель.

Малоизвестен факт, что в течении 6–9 месяцев после коклюша простуда или любая респираторная инфекция может снова вызвать характерный кашель, поскольку пока полностью не отрастут ворсинки, удаляющие слизь из легких, любая инфекция снова вызывает накопление слизи и возобновление лающего кашля.

Нет, до сих пор не проводилось контролируемых клинических исследований по витамину С для лечения коклюша. Официальное признание этого эффективного лечения коклюша лишит продвижение вакцин мощного эмоционального рычага "коклюш не лечится".

Остается лишь надеяться в интересах грядущих жертв любых форм менингита и сепсиса, а также младенческого коклюша, что врачам не потребуется еще двадцать лет, чтобы понять, что витамин С способен предотвратить пневмонию и другие осложнения у маленьких и недоношенных детей как при коклюше, так и при любых других токсиномедиируемых болезнях 32,33,34,35,36.

ПРИМЕЧАНИЯ
1 Goshima, T. et al. 1990. "Passive Transmission of Pertussis Antibodies". Manclark, C.R. (ed) 1990. Sixth International Symposium on Pertussis. Abstracts. Department of Health and Human Services, United States Public Health Service, Bethesda, Maryland. DHHS Publication No (FDA) 90–1162. 260 pages. "Антитела легко проходят плацентарный барьер в соответствии с количеством антител у матери. Таким образом, может приобретаться пассивный иммунитет к коклюшу". Abstract 48, p. 174.
2 Bass, J.W. and Zacher, L.L. 1989. "Do newborn infants have passive immunity to pertussis?" Pediatr Infect Dis J, Vol. 8: 352–3. "В период до введения прививок против коклюша беременные, которые сами, как правило, болели в детстве коклюшем, могли пассивно передавать специфические антитела, которые защищали их новорожденных детей, обеспечивая им защиту от коколюша в первый год жизни... в противоположность нынешней практике, где только вакцины обеспечивают иммунитет... который не является ни гарантированным, ни долговечным, в результате чего большинство молодых женщин детородного возраста восприимчивы к коклюшу... и не передают пассивного иммунитета своим детям". PMID:2748237.
3 Rosenthal, M. 1996. "Vaccinating moms to protect baby may be a practice whose time has come" Infectious Diseases in Children, August: p. 28. "Изучение цельноклеточной вакцины от коклюша в 1945 г. показало, что вакцина безопасна, и у 57 беременных женщин она привела к трансплацентарной передаче антител".
4 4 Helmy, M.F. et al. 1992. "Bordetella pertussis FHA antibodies in maternal/infants sera and colostrum. J. Egypt Public Health Assoc, 67(1–2): 195–212. PMID:1295946.
5 5 Kassim, O. et al. 1989. "Class-specific antibodies to Bordetella pertussis, Haemophilus influenzae type b, Streptococcus pneumoniae and Neisseria meningitidis in human breast milk and maternal-infant sera". Ann Trop Paediatr December 9(4): 226–232. PMID:2482004.
6 Tripodi, V. et al. 1988. "Vertical transmission of immunity against B. pertussis." Boll 1st Sieroter Milan, Vol. 67(5-6):357–62. PMID:2908739.
7 Hakannson, A. et al. "Apoptosis induced by a human milk protein". Proc Nat Acad Sci, Vol. 92(17): 8064-8. PMID: 7644538. "В грудном молоке содержится широкий набор молекул, таких как антитела, бактериолизины и ингибиторы бактериальной адгезии, ограничивающих деятельность микробов. Мультимерный альфа-лактальбумин убивает все трансформированные, зародышевые и лимфоидные клетки, но не трогает зрелый эпителий... Молоко укрепляет иммунитет слизистых не только тем, что содержит противомикробные молекулы, но также регулировкой функций лимфоцитов и эпителия..."
8 Bass, J. et al. 1989. "Do newborn infants have passive immunity to pertussis?" Pediatr. Infect Dis J, 8:352–3. PMID:2748237.
9 Darmstadt, G.L. et al. 1992. "Measles in mother-infant pairs." Pediatr Infect Dis J, June 11(6):492-3. PMID: 1608688.
10 Kacica, M.A. et al. 1995. "Measels antibodies in women and infants in the vaccine era." J. Med Virol, Feb; 45(2): 227–9. PMID:7775944.
11 Rosenthal, M. 1996. "Vaccinating moms to protect baby may be a practice whose time has come." Infectious Diseases in Children August: Newsletter. p. 28.
12 Grant, C. et al. 1997. "A comparison of two pertussis epidemics in Auckland." NZMJ, May 23; 110(1044):182–4. PMID:9201203.
13 Johnston, M. 2004. "Coughing kids may be banished." New Zealand Herald, 9 December: A3. Цитируется Dr. Will Paterson, Auckland Regional Public Health.
14 Johnston, M. 2004. "Coughing kids may be banished." New Zealand Herald, 9 December: A3. "Доктор Долтон отметила, что вакцина не из лучших".
15 Tozzi, A.E. et al. 2003. "Clinical Presentation of Pertussis in Unvaccinated and Vaccinated Children in the First Six Years of Life." Pediatrics, November: 112(5):1069–75. PMID:14595048.
16 Farizo, K.M. et al. 1992. "Epidemiological Features of Pertussis in the United States, 1980–1989." Clinical Infectious Diseases, Vol. 14:708–19. PMID:1562663.
17 Mertsola, J. et al. 1983 "Intrafamilial spread of pertussis." J. Pediatrics, Sep; 103(3):359–63. PMID:6886900.
18 Сейчас считается, что большинство видов E. coli полезны для человеческого организма, но некоторые не полезны. Считается, что такие палочки кодируют белок, убивающий клетки в организме. Но если обратиться к немалому числу более ранних исследований, то можно увидеть, что ранее все типы кишечной палочки считались потенциально опасными ПРИ УСЛОВИИ, что их число резко увеличивается в подвздошной кишке и в тонком кишечнике. Вторжение кишечных палочек в эти области тонкого кишечника, обладающие большей поглощающей способностью, вызывает поглощение увеличивающегося количества липополисахаридов (ЛПС, также известных как эндотоксин или курлин), что может вызвать цепную реакцию, вплоть до смертельной. Кишечные палочки в норме находятся под контролем благодаря равновесию микрофлоры в желудочно-кишечном тракте и при нормальной работе печени, но для борьбы с эндотоксином телу нужно достаточно витамина С. Другие грамотрицательные бактерии также могут производить такой же эндотоксин. Эндотоксемия — очень непростая для изучения тема. Для поиска первичной информации можно ввести слова "Эндотоксин" и "Витамин С". Cм. также http://www.acnem.org/journal/24-1_april_2005/endotoxin.htm and http://tomlevymd.com/vcthree.htm
19 Ashton, T. et al. 2003. "Exercise-induced endotoxemia: the effect of ascorbic acid supplementation." Free Radic Biol Med. August: 35(3):284–91. PMID:12885590.
20 Например, у младенцев на искусственном вскармливании или у детей с кишечной микрофлорой, измененной при назначении сильных антибиотиков без последующей коррекции пробиотиками.
21 Я использую "витамин С" и "аскорбат натрия" как взаимозаменяемые названия. Биохимически нейтральной и предпочтительной формой витамина С является аскорбат натрия. Не обманывайте себя, покупая что-то другое. Другие формы могут дать временное облегчение, но они нежелательным образом влияют на химические реакции в организме.
22 Professor Hattori, 1936. "Concerning the vitamin C therapy of whooping cough." Klinische Wochenschrift, December: 15(51):1884–1885. Взято 18 сентября 2005 г. с http://www.seanet.com/~alexs/ascorbate/193x/otani-t-klin_wchnschr-1936-v15-n51-p1884-eng.htm
23 Для поиска медицинских статей можно использовать ресурс http://www.nebi.nlm.nih.gov/entrez/query.fcgi. Вы увидите ссылку с номером PMID, что и будет идентификационным номером системы Pubmed.
24 2002. "Selenium too important to ignore." Christchurch Press, 22 June: D15. Ссылка на Университет Отаго.
25 Levy, T.E. 2002. Vitamin C, Infectious Diseases, and Toxins: Curing the Incurable, Philadelphia, Xlibris Corporation. ISBN 1-4010-6964-9.
26 Hickey, S. and Roberts, H. 2004. Ascorbate: The Science of Vitamin C. Lulu Press. ISBN 1-4116-0724-4.
27 Clemetson, C.A.B. 1989. Vitamin C. CRC Press Inc, FL. 33431, USA. Volume 1: ISBN 0-8493-4841-2 318 pages. Volume 2: ISBN 0-8493-4842-0 236 pages. Volume 3: ISBN 0 8493-4843-9 264 pages.
28 Long, C.L. et al. 2003. "Ascorbic acid dynamics in the seriously ill and injured." J Surg Res, 109(2):144–8. PMID:12643856.
29 Galley, H.F. et al. 1996. "Ascorbyl radical formation in patients with sepsis: effect of ascorbate loading." Free Radic Biol Med, 20(1):139–43. PMID: 8903690.
30 Voigt, K. et al. 2002 "Decreased plasma and cerebrospinal fluid ascorbate levels in patients with septic encephalopathy." Free Radic Res 36(7):735–9. PMID:12180123.
31 Godfrey, M.E. 2004. "Haemorrhagic meningococcal meningitis: is it scurvy?" New Zealand Medical Journal, August: 117(1200) Взято 18 сентября 2005 г. с http://www.nzma.org.nz/journal/117-1200/1029/ PMID: 15475995.
32 Hemila, H. et al. 1999. "Vitamin C and acute respiratory infections." Int J Tuberc Lung Dis, Sep; 3(9):756–61. PMID:10488881.
33 Hemila, H. 2004. "Vitamin C supplementation and respiratory infections: a systematic review." Mil Med, Nov; 169(11):920–3. PMID:15605943.
34 Wintergerst, E.S. et al. 2006. "Immune enhancing role of Vitamin C and zinc and effect on clinical conditions." Ann Nutr Metab, 50(2):85–94. PMID:16373990.
35 Bakaev, V.V. et al. 2004. "Ascorbic acid in blood serum of patients with pulmonary tuberculosis and pneumonia." Int J Tuberc Lung Dis, Feb; 8(2):263–6. PMID:15139458.
36 Johnson, M. 2004. "Whooping cough kills baby." New Zealand Herald 7 July:A3. Цитируя д-ра Лиз Сегедин, "заболевшие младенцы плохо поддаются лечению. Антибиотики могут убить бактерию-возбудителя, но поскольку это токсиномедиируемое заболевание, вред будет продолжаться и после антибиотиков, в особенности для недоношенных новорожденных. У них может развиться высокое давление в сосудах легких и пневмония".

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