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TDaP cocooning against pertussis was well accepted for high-risk population
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ATLANTA — Immunization with tetanus-diphtheria-acellular pertussis in mothers and other infant contacts, also known as “cocooning,” was successfully implemented using standing orders and onsite vaccinations, according to study results presented at the 44th National Immunization Conference.
C. Mary Healy, MD, of Baylor College of Medicine in Houston, Texas, who presented the research, and colleagues from Texas Children’s Hospital sought to implement cocooning in a predominantly Hispanic, medically underserved, uninsured population at Ben Taub General Hospital in Houston.
“The incidence of pertussis is up to 20-fold higher in infants who are too young to complete an immunization series, and pertussis-related complications and deaths occur almost exclusively in this age group,” Healy said during the presentation. “Another interesting fact about the epidemiology is that infants of this study’s ethnicity are overrepresented both in pertussis incidence, which is up to 74% higher, and pertussis-related deaths.”
Healy also noted that over 75% of pertussis-infected infants acquire the disease through household contact, especially from their mothers.
The researchers used a phased approach to implement TDaP immunization among mothers and other infant contacts. Phase one of the researchers’ plan involved issuing a standing order for postpartum TDaP from January 2008 to June 2009 to mothers before infant discharge.
Phase two, which began in June 2009, also offered immunization to other infant contacts at the hospital, according to Healy.
Healy explained that pertussis education was also given to health care personnel, and bilingual educational materials about TDaP were offered to all mothers.
The researchers interviewed mothers to determine the number of additional infant contacts eligible to receive TDaP, noted Healy, and consenting eligible contacts received TDaP before the infant was discharged.
Results revealed that 73% of mothers received TDaP between Jan. 7, 2008, to Jan. 31, 2010, with 92.2% identifying as Hispanic. The researchers reported that vaccine refusal was also three times higher among black women, according to Healy.
A total of 1,860 other infant contacts received TDaP from June to January 2010, Healy said. The median number of TDaP eligible contacts per infant was three, and a median of two were immunized. The researchers also noted that two-thirds were fathers, and 98% received TDaP within one week of infant discharge.
Data also indicated the following about contacts who received TDaP:
- 55% did not know when last tetanus shot was.
- 95% were Hispanic.
- 7% were adolescents.
- 87% resided in the household with the infant.
No significant adverse events were reported, said Healy, but the researchers identified the following barriers to TDaP immunization: the need for extended immunization hours; inaccurate recall of vaccination history; and visiting restrictions — which were lifted only two weeks ago — related to pandemic H1N1 influenza. – by Melissa Foster
While pertussis does cause morbidity in adults, morbidity and mortality are significantly greater in children and especially in infants. It is therefore extremely important to assure that adolescents and adults receive this vaccine both to prevent and abort outbreaks and protect persons, like infants, who are susceptible to pertussis.
– Eugene Shapiro, MD
Professor of pediatrics, epidemiology and investigative medicine, department of pediatrics, Yale University School of Medicine
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