Public Health Report

Andrew Resignato, MS

Cocooning: A Strategy to Prevent Pertussis in Infants

I n 2010, California experienced a serious pertussis (whoop- Second, providers can remind patients with infants that they ing cough) epidemic that took the lives of ten infants and and their family members should all be vaccinated to protect hospitalized more than 475. Preventing deaths and hospital- the infant. Every office visit is an opportunity to vaccinate and ization in infants from pertussis is a critical public health issue. create a cocoon of protection around a newborn. Cocooning is a term that describes the process of immuniz- In addition to on-time immunization of infants, reducing ing all contacts of newborns with pertussis-containing susceptible people around a newborn by cocooning offers the (either DTaP for children less than seven years old or Tdap for best way to decrease the spread of pertussis to the population those over seven) to form a protective ring of from that bears the highest burden of the disease. Efforts in this direc- this disease for infants. Contacts can include mothers, fathers, tion representAndrew Resignato, a high standard MS, is director of health of carethe San and Francisco an intervention Immu- grandparents, siblings, nannies, and babysitters. Health care nizationthat will Coalitionimprove (ofthe which health the of SFMSall Californians. is a member organization). providers are also part of the cocoon, as they may have regular contact with a newborn. The San Francisco Immunization Coalition has educa- Studies1 have shown that caregiversRo transmitRo pertussis to tional materials (posters and DVDs) for providers about infants. Pertussis is extremely contagious, with a high attack pertussis and cocooning. For more information, go to www. rate or basic reproduction numberRo ( ). The for pertussis sfimmunize.org. is estimated at 12-17, which is similar to measles and in con- trast with influenza, which has an of 1-2. Ninety percent of References susceptible household contacts become infected2 with pertussis Bordetella pertussis when a household member contracts the disease. In 2005, a San Pediatr Infect Dis J. Francisco mother contracted pertussis while in the hospital and 1. Transmission of to young infants. spread the disease to her newborn. The infant was hospitalized 2007; 26: 293-299. and eventually died from the complications of the disease. 2. California Department of Public Health Report. August Although it may be higher in California, national data 2010. indicate that the Tdap immunization rate for family members 3. National Health Interview Survey. MMWR 2010; 59:1302-6.

of newborns is well below3 10 percent and only 17 percent for 4. ACIP provisional recommendations for health care per- health care workers. For these two groups, there is real room sonnel on use of tetanus Centerstoxoid, reducedfor Disease Control and for improvement. accellular (Tdap) and use of postexposure an- Hospitals have an important role in facilitating the cocoon- timicrobial prophylaxis. . April 2011. ing process. All birthing hospitals in San Francisco are immu- nizing pregnant or postpartum women with Tdap. Two San Francisco birthing hospitals have gone further. The University of California San Francisco and San Francisco General have set up programs to immunize family contacts of newborns, even those who are not their patients. This model of prevention and good public health should be carried out by all birthing hospitals across California. Health care providers outside of the hospital setting can

also play a role in the cocooning process. First, they themselves4 262726 S Sanan F Franciscorancisco M Medicineedicine M Mayay 2011 2011 www.sfms.org www.sfms.org shouldwww.sfms.org be vaccinated, a fact that can be forgotten by providers. May 2011 San Francisco Medicine 27