Protecting Infants Through the Concept of “Cocooning”
Jun 12, 2010

By Christine Vara
Cocooning: A transitive verb meaning to protect somebody from unpleasantness or danger.
And who wouldn’t want to protect infants from danger?  The question is what do we need to protect them from and how do we do it?
In the case of whooping cough (also known as pertussis) infants are in very real danger.  Whooping cough is a serious bacterial infection that attacks the respiratory tract, resulting in severe coughing spasms.  Adults who contract pertussis often have symptoms that can persist for as long as 3-4 months, which is why it has been coined the 100 day cough.  Symptoms in adults often mimic a severe cold and so many go patients are undiagnosed, perpetuating the spread of the disease. 
However the infection has proved to be particularly life threatening for newborns and infants since the coughing spasms can escalate, restricting an infant’s airways and resulting in dangerous apnea.  The disease is highly contagious and is spread from exposure to infected persons through droplets in the air that come from coughing and sneezing.  Complications from pertussis can lead to pneumonia, seizures, brain damage, mental retardation, and death.  While the mortality rate from whooping cough may not seem alarmingly high, the fact is that 90% of people who die from this disease are babies less than one year old.  Since this is a disease that can be prevented through vaccination, any death seems unacceptable. So what can we do to protect our children?  
The good news is that there is a vaccine available for children called DTaP, which provides immunization against whooping cough, (as well as tetanus and diphtheria).  The CDC recommends that infants receive 5 doses at ages 2, 4, 6, and 15-18 months, followed by another at 4-6 years of age to complete the series.  Unfortunately, since infants don’t begin the multi-dose vaccine until 2 months of age,and it requires multiple doses to build immunitity, children are virtually unprotected in the early months of their lives.   
It is possible that a mother’s antibodies can pass to a baby to protect them during this critical time.  However, since immunity may only last 10 years, people who received the vaccination when they were young are typically no longer immune as adults, but don’t even realize this.  This was recently publicized by Dr. William Cochran, a pediatric gastroenterologist from Geisinger Medical Center in Danville, PA who contracted the contagious bacterial disease from a child he was caring for last year and described his battle with whooping cough as the worst illness of his life.  
Fortunately, in 2005 the Tdap vaccine was approved for adults, up to the age of 65, in an effort to reduce the rising rates of pertussis.  Surprisingly, unlike many other diseases, even those who have contracted the disease in the past do not remain immune from the disease in the future.  In recognizing this, many states are now requiring a booster shots for middle school students in order to extend a child’s immunity, but many adults still don’t receive booster shots for themselves because they just aren’t aware that they should.  The alarming fact is that 70% of infants who contract pertussis are actually infected by family members including mothers, fathers, grandparents and siblings.    
Enter the concept of cocooning – a practice of ensuring the vaccination of all individuals that newborns will come into contact with during their early days in order to protect them from the transfer of harmful illnesses like pertussis.  By getting the public to understand the risk of whooping cough to infants in our community, hopefully more people will request the Tdap vaccine from their doctor.  Some local pharmacies are now administerering the Tdap vaccines to adults, so while accessibility may not be an issue, clearly education is. 
While we know that the adult vaccine has been available since 2005 and is easily accessible, we must question why most adults are still not aware of the need to vaccinate against pertussis as a preventive measure for ourselves and our children.  Our collective efforts must now turn to generating a patient driven initiative to increase the number of people who seek immunization.      
While the vaccine is not recommended for use during pregnancy, we need to educate women so that they are seeking vaccination prior to getting pregnant, or immediately after giving birth. With increased awareness of the risk, perhaps OB-GYNs will begin to make this suggestion during pre-conception or pre-natal visits. Additionally, since the body’s immune response to the vaccine may take as long as 4 weeks, the recommendation is for all family members and care givers who will come in contact with the baby to be vaccinated at least 4 weeks prior to delivery.    Taken one step further, it would be prudent for hospital workers and  pediatric offices employees, who are often the first contacts for newborns, to be vaccinated against this infectious illness as well.  
Unfortunately, we are seeing a noticeable increase in the cases of pertussis this year in comparison to years past.  Consider recent articles regarding a rise in cases in such places as California. It is a tragedy that 4 infants have already lost their lives this year in the state of California alone as a result of pertussis.
At the Vaccinate Your Baby website, victims of vaccine preventable diseases have shared their heartbreaking stories in an effort to help save other children.  The Romagueras detail their experience with their daughter Brie who was born, and subsequently died, as a result of whooping cough in 2003, prior to the introduction of an adult booster shot.  Yet Katie Van Tornhout’s recent story of the death of her daughter Callie illustrates that parents are still not aware of the risks that pertussis poses, or the steps that they can take to reduce those risks through widespread immunization.  Therefore, while we have a way to prevent these deaths, we don’t have enough awareness prompting families to receive the vaccinations they need to protect their own children. 
Please help us to do our part to inform parents of the cocooning concept and share this information with others.  Of course, we also welcome any suggestions or comments you may have so I encourage you to join the conversation here.      
 I would like to thank Ari Brown, MD, FAAP and Danielle Romaguera for their contributions to this article.  Hearing them speak at length on this subject is what facilitated me to write this piece.  I think it is important to note that there are people working hard to get the word out and both Dr. Ari Brown and Danielle Romaguera are very committed to educating families regarding the risks of pertussis.  
  Not only is Dr. Brown an award-winning pediatrician who works full-time in private practice in Austin, Texas, she is a mother to two boys, an official spokesperson for the American Academy of Pediatrics, an expert contributor to WebMD and author of two best-selling parenting books, Baby 411 and Toddler 411.  Her newest book, Expecting 411 is her latest accomplishment in a comprehensive series of great resources for expectant parents. 

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