Cocooning to Protect Unvaccinated Babies, Beneficial or Not?

According to Reuters Health, a large group of U.S. doctors have given the go ahead for pediatricians to offer vaccines to close family members of babies who are too young to get shots themselves.  It’s also becoming a remotely popular thing to do when a sick child is unable to get CDC recommended vaccinations.  But, what exactly is cocooning, and do you believe it is beneficial or not?

The “cocoon strategy” aims to protect newborn infants from becoming infected with pertussis by administering Tdap (tetanus, diphtheria and acellular pertussis) booster vaccines to mothers and family members of newborn infants. In this way, mothers and family members are protected from getting pertussis and passing it on to their young infants. It has been recommended by the Centers for Disease Control and Prevention (CDC) since 2006 but is not routine in healthcare organizations.

But earlier this month, Canadian government researchers suggested that at least for whooping cough, a major infectious disease worldwide, cocooning comes with a hefty price tag.

They estimated that to prevent one infant death from the disease in Quebec or British Columbia, at least one million parents would have to be vaccinated — at a cost of some 20 Canadian dollars per shot.

“This program appears inefficient,” said Dr. Danuta Skowronski, of the British Columbia Center for Disease Control in Vancouver.

“In fact, the criteria for this to be successful are almost impossible,” she told Reuters Health. “We’re not saying that babies are not important — of course they are — but we have to be wise about how we use our finite resources.”

The new American Academy of Pediatrics’ report on cocooning, released in the journal Pediatrics, is not directly recommending that pediatricians start offering parents shots — a practice that has been controversial.

“What it says is, if you choose to do it, this is ok,” said the AAP’s Dr. Herschel R. Lessin, who worked on the report. “They give flu shots in airports and pharmacies. There is really no reason why a licensed doctor can’t give them also.”

Lessin said the main focus is on flu shots and the TDaP vaccine, which protects against tetanus, diphtheria and whooping cough (pertussis).

There is already a national U.S. mandate to give these vaccines to everybody, he added, including pregnant women. But babies have to be at least six weeks old to get the TDaP vaccine and six months old to get a flu shot.  In the meantime, their only protection is through antibodies they get from their mother in the womb and in breast milk if she has been vaccinated or has natural immunity against the infections.

Lessin said that because not all pregnant women get vaccinated, cocooning is still a reasonable strategy to shield infants.  “The goal here is to get everyone immunized,” said Lessin. “As pediatricians, we think immunization is the greatest thing in the history of mankind.”

Because it’s a “hassle” for pediatricians to bill parents’ insurance for the shots, he said the most practical thing is to have people pay out of pocket for the vaccines — in the case of a flu shot, around $30.

Lessin acknowledged that there isn’t much evidence on how effective cocooning really is.  “It’s a relatively new concept,” he said. “I don’t know that anyone has looked at whether it works.”