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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15 responses to “Protecting Infants Through the Concept of “Cocooning””

  1. Laura says:

    according to the CDC, pregnant women CAN receive the vaccine!!

    • christinevara says:

      Thank you for including this resource.
      I would caution that patients review the CDC recommendations carefully. Please note that there is a difference between the Td vaccine and the Tdap vaccine. In regards to the Tdap vaccine, the information from the CDC reads, “Data on safety, immunogenicity and the outcomes of pregnancy are not available for pregnant women who receive Tdap. When Tdap is administered during pregnancy, transplacental maternal antibodies might protect the infant against pertussis in early life. They also could interfere with the infant’s immune response to infant doses of DTaP, and leave the infant less well protected against pertussis.”
      They go on to explain, “In some situations*, healthcare providers can choose to administer Tdap instead of Td to add protection against pertussis. When Td or Tdap is administered during pregnancy, the second or third trimester is preferred,” This information is footnoted with an article entitled, ” Prevention of Pertussis, Tetanus, and Diphtheria Among Pregnant and Postpartum Women and Their Infants, Recommendations of the Advisory Committee on Immunization Practices (ACIP) which can be referenced at
      It is important to note that the CDC also recommends that, “Providers who choose to administer Tdap to pregnant women should discuss the lack of data with the pregnant women and are encouraged to report Tdap administrations regardless of the trimester, to the appropriate manufacturer’s pregnancy registry.”
      Thanks again for your valuable contributions. Christine

  2. Felicia says:

    As a parent that lost our newborn ( 7 weeks) to pertussis, I wish someone would have told me. If given the option I would have taken the shot and so would my family. They pushed the flu/swine vaccine but never mentioned anything else. It was heartbreaking watching our son slowly die over 9 days and it could have been prevented.

  3. laura says:

    Felicia, my heart just breaks for your loss. I only hope that lives will be saved because of your tragedy. When I had my daughter in September I ask the nurse for the DTaP and shes said I didn’t need it, I’d been vaccinated in grade school. I knew she was wrong and should have stood up to her. My daughter got Pertussis at 8 weeks of age.
    Christine, thanks for the clarificiation. I wish there was more straightforward guidance, because if it takes a couple weeks for you to mount an immune response to a vaccine, wouldnt’ you be vulnerable when your baby was most at risk. Is the adult booster just so new it hasn’t been fully studied yet?
    I’m also confused about people who got the Td and were told to wait 5 yrs to get the DTaP. Is that *really* necessary?? Is there any way around it. and WHY are doctors still giving the Td instead of the DTaP to women of childbearing age?! It is unbelievable to me that doctors aren’t better informed.

    • Christine Vara says:

      Thanks for your comments and insightful questions. I’m sorry to hear that your daughter battled pertussis and it’s unfortunate that your nurse wasn’t better educated on this in order to help you prevent this. I sincerely hope your daughter has recovered well and that you will use this experience to help educate others.
      In order to address your specific medical questions, Dr. Brown has responded to you personally as follows:
      Those are great questions.
      Here are some answers:
      1. It takes at least 2 weeks to mount an immune response to Tdap vaccine, so ideally those in a household with a baby under a year of age should get the vaccine at least 4 weeks prior to the baby arriving home. So, while vaccinating a mom after delivery is not ideal, it is the current official recommendation. Studying pregnant women and any medication/vaccine is always tricky, so that’s why there is not a recommendation from CDC for women to receive the shot during pregnancy. However, other medication advisory groups have said it is safe for pregnant women to get Tdap, particularly if there is a significant risk of exposure to the disease. It’s possible the universal recommendation will change in the future, but this is what it is right now.
      2. A person can receive a Tdap vaccine even if it has only been 2 years since getting their Td. They do not have to wait 5 or even 10 years to get it.
      3. Yes, all adult providers should offer Tdap. It’s a challenge because some providers do not view themselves as vaccine providers (when they should!) and if they have an office that does not routinely give a ton of vaccines, they may end up eating the cost of the vaccines that expire when they go unused. It’s an overhead risk for some practices. Then, there are other concerns about insurance companies covering the cost for the vaccine. Again, some providers fear that a patient might have to pay out of pocket for the vaccination and then not be interested in getting it–again, leaving the provider with expired vaccine that they purchased and it went unused. So, these are some of the practical issues that need to be addressed to make this routine or standard of care. It should be a no-brainer for health insurance companies to cover the small cost for preventative care—as the result of getting the disease is much more expensive.

  4. laura says:

    This is great to know–thank you, Christine and Dr. Brown! You guys are doing such important work, I really appreciate it.
    My daughter made a complete recovery, we were fortunate and are very grateful to her pediatrician.

  5. Corinna says:

    My grandaughter is 41/2 months old. I’m 49 and have had a persistent irritation in the back of my throat with a dry cough for about 5 or 6 months. Maddie has had a little cough and ocassional sneeze for about a month. She had her 2 month and 4 month shots, but obviously not her 6 month shots. We recently saw an ad on TV about pertussis and I became worried. We asked her pediatrician about it and they said she didn’t have pertussis (but they didn’t really do any tests). We’re going to ask them again – but my question is: should I (and the rest of my family) get the vaccine now – not knowing if I have it or if Maddie has it? I’m worried about our precious little one. Answers…anyone? Thank you …

    • christinevara says:

      It sounds as though you are very concerned, and with the persistent symptoms you described, I can understand why.
      I forwarded your comments to Dr. Brown and she responded as follows: “Adults and parents, and the baby can be tested for pertussis. The people who have had a persistent cough can be treated pending the test results if there is a concern. The baby could have additional blood work and a chest xray to evaluate for pertussis. But if the cough has been going on for more than 10-14 days it is worth pursuing the evaluation.”
      Inquire with your doctor if they can administer a Tdap booster to protect you (and thereby help protect your grandaughter) from pertussis. There is no evidence to show any harm in receiving the vaccine even if you were to later be diagnosed. If they don’t have the vaccine available, and can’t or won’t order it, you can check with your local pharmacy, as they typically have the vaccine and can also administer it.
      In regards to Maddie’s care, I would be persistent in requesting further evaluation from her doctor to ensure that this is not a case of pertussis. As Dr. Brown suggested, there are specific tests that can be run and it’s better to be cautious when it comes to the health of an infant.
      It is also recommended that any family member, caregiver or friend who spends time with Maddie be vaccinated to protect her during these crucial months before she receives full immunity from the complete series of shots.
      We would love to hear back from you to ensure that everyone is healthy, and we are interested in hearing how the doctors handled your care, as well as Maddie’s.
      We appreciate you reaching out to us and wish you all the best.

  6. heather says:

    We are expecting a baby in a few weeks, followed by a series of visits from grandparents (ages 70 and 71, respectively). My own parents were able to get the DTAP vacccine no problem (they live in Oregon), but when my husband’s parents in Illinois tried to get the vaccine they were told that, due to their age, the DTAP vaccine cannot be administered to them. They are both completely healthy, and my understnading is DTAP was a dead vaccinne, so it is unclear why the CDC would recommend protecting them against a safe vaccine, vs. protecting our baby. Can someone help, or offer any guidance? Is there anywhere else I can call in teh Chicago area?
    Thank you so much,

    • christinevara says:

      Heather, we are being asked this question by many people out there who are seeking to get the grandparents of newborns vaccinated. While the Tdap vaccine is only recommended for 7 – 64 year olds, there are instances when this recommendation can, and should, be expanded, such as during an epidemic. For example, there is currently a declared epidemic of pertussis in the state of California. In response to this, the California Department of Public Health is now recommending an adolescent-adult pertussis booster vaccine (Tdap) for:
      • anyone 7 years and older who is not fully immunized, including those who are more than 64 years old,
      • women of childbearing age, before, during, or immediately after pregnancy, and
      • other people who have contact with pregnant women or infants.
      to include…now for (can you pull exact wording). For more info on this particular recommendation, you can check the reference at
      If I were having a baby in the near future, and my parents were older than 64, I would suggest that they have a good discussion with their doctors about the benefits of considering an off-label recommendation to receive the vaccine. With annual cases estimated near 900,000, it would appear that we are all at risk of transmitting pertussis to vulnerable newborns and every precaution would be prudent.
      I hope this information has been helpful to you.
      Amy Pisani, Executive Director
      Every Child By Two

  7. heather says:

    Thank you so much for this. This is very helpful, and I am hopeful that our family members will be able to resolve this with their physician in order to protect their grandchild. I will let you know how this is resolved. Thank you again.

    • christinevara says:

      Heather, We are happy to help in any way we can. We would certainly appreciate it if you could keep us informed in regards to this issue. Every Child By Two is working hard to promote positive change from within the medical system, but as parents and patients, we must continue to encourage dialogue directly with our providers. Wishing you a healthy pregnancy. Christine from Shot of Prevention

  8. […] order to protect those too young to be vaccinated, we must rely on the concept of cocooning, where all the individuals around the child are immunized in an effort to shield the baby from […]

  9. Cassie Grantham says:

    This article needs updating as Tdap vaccination is now approved for late second trimester and 3rd trimester pregnant women!

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