Cocooning, a vaccination strategy endorsed by the Centers for Disease Control and Prevention, helps protect infants from pertussis by immunizing family members around them.

What is cocooning and why was it introduced?

Cocooning was developed to protect vulnerable infants from pertussis, also known as whooping-cough, which is a respiratory infection that can prove deadly in newborns prior to them being able to receive their own protection through immunization. The Tdap vaccination is offered to family members to prevent pertussis infection from those who come in frequent contact with the newborn. Statistics from the Centers for Disease Control and Prevention (CDC) reveal that more than half of infants younger than 1 year of age who get pertussis end up hospitalized. The younger the infant, the more likely hospital treatment will be necessary. Of those infants hospitalized with pertussis, around 1 in 5 will contract pneumonia and 1 in 100 will die.

Starting with the mother, what is the most effective plan to implement cocooning with everyone who comes in contact with the infant?

In the past few years, mothers, fathers and other immediate family members who will provide care for the infant have been vaccinated. According to the CDC, the recommendation now states that health care providers should administer a dose of Tdap during each pregnancy regardless of the patients prior history of receiving the vaccine. Optimal timing to administer Tdap is between 27 and 36 weeks gestation in order to maximize the mothers antibody response and passive antibody transfer to the infant during their most vulnerable time, before three months of age.

How effective has cocooning proven to be?

Reports from the Nevada State Immunization Program, which piloted the first full-scope cocooning program in the United States in 2006, state that the current national case incidence rate for pertussis is 13.4 cases/100,000 persons; in Nevada, the case incidence rate is 4.08/100,000, demonstrating the effectiveness of almost seven years of cocooning in the state. Our hope is that other programs will replicate this success rate throughout the nation.

Debbie Lebalch, MSN, RN, is Nurse Manager of the Baby & Family Suites and Newborn Nursery at Renown Health in Reno, Nev. Renown children’s Hospital was the first in the nation to offer the cocooning program.