Recently there have been several news articles about cocooning.  No, it’s not a way to raise butterflies in your backyard. It means surrounding high risk people, especially infants, with other people who have been vaccinated against one or more diseases.  The idea is that people who are vaccinated against disease are less likely to carry that disease home.  Besides infants, high risk people include those on chemotherapy for their cancer, pregnant women, the elderly, those with HIV, people with asthma or cystic fibrosis or those on long term steroids, including people who have had an organ transplant .

The two diseases most commonly targeted are influenza and pertussis (whopping cough.)  Infants cannot be vaccinated against the flu until they are 6 months old; they start their pertussis vaccine series at age 2 months but are not fully protected (depending on the child) until after their 3rd (at 6 months of age) or 4th (usually around 15 months of age) dose.  Hence these children rely on maternal antibodies from crossing the placenta before birth or to less extent, those found in breast milk.  Those received before birth usually last about 6 weeks; the effect is much stronger if mom was vaccinated during pregnancy.

In the past few years, there has been a resurgence in the number of whooping cough, and sadly, an increased number of infants dying from the disease.  About 2/3 of infants less than 2 months of age who get whooping  cough get hospitalized for pneumonia or seizures and not infrequently need to be on ventilators.  Children who die from whooping cough usually suffocate, with the blood vessels in their lungs so clogged that new blood cannot enter to carry oxygen to the rest of the body.  Brain damage can also result from the illness.

In the past, efforts have focused on vaccinating mothers, either while pregnant or immediately after giving birth.   Pregnant women are themselves at high risk for complications, including death, from influenza.  One of the saddest days of my career was during my residency, when a pregnant mom died on the operating table from influenza right before Christmas.  It was clear she would not survive the infection, so a C-section was done to save the baby.  The mom died less than 12 hours after her first symptoms.  Miraculously, the baby lived.

Vaccinating mom during pregnancy protects her as well as maximizing the amount of antibodies transferred to the baby.  In June 2011 the American Committee on Immunization Practices (ACIP) officially changed its recommendation to vaccinating against pertussis during pregnancy, instead giving it immediately post-partum.  It noted that the vaccine had been determined to be safe and effective during pregnancy, and vaccinating during pregnancy improved the amount of antibodies transferred to the baby.  In addition, mothers were found to be the source in over a third of infected babies.

Recent efforts have encouraged vaccination against pertussis and influenza for all people with close contact with infants, including dads, grandparents, old siblings and child care workers.  Sadly, this approach has been slower to catch on, in part because these people are usually being seen in a doctor’s office on a regular basis.  This fall, the Larimer County Health Department received a grant to offer the pertussis vaccine (also known as Tdap) to family members of newborns for free.  Unfortunately, the grant has expired so the vaccine is no longer free, but fortunately it is still available for a small fee.

A recent article from Canada questioned the cost –effectiveness of cocooning.  There are very little actual data, so instead researchers created a model and predicted that 1 million people would have to be vaccinated to prevent 1 infant death; fewer people would need to be vaccinated to prevent hospitalization or illness.  However, even the accompanying editorial noted the cost of the Tdap vaccine was trivial in comparison to the overall cost of a delivery.

The influenza and Tdap vaccines are available at the health department, many pharmacies and most doctors’ offices who serve adults.  So if you’re the parent or close contact of an infant, roll up your sleeve and take one for the team.  You will be rewarded with a beautiful smile from your little butterfly.

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