Cocooning Your Newborn Baby

Cocooning Baby

Every mother wants to do whatever she can to protect her precious newborn from infectious diseases. Some of the most well known steps include breastfeeding, immunizing the infant, and good hand washing. Another way to protect your baby is to cocoon her.

What Is Cocooning?

Cocooning means making sure that everyone who comes into contact with your baby is immunized: mom, dad, siblings, grandparents, relatives, friends, any other care providers, and just about everyone else.

While all vaccines are important, some are more important than others for newborns, especially the whooping cough (pertussis) and influenza (flu) vaccines.

Whooping cough is an illness that anyone can get at any age. For most adults, pertussis is a mild illness with an annoying cough. But for young infants, the disease can be severe. Often, infants with pertussis can have apnea (times when they stop breathing.) Whooping cough can be fatal in newborns, who can’t begin to be immunized against pertussis until 6 weeks at the earliest. In 2006, the Advisory Committee on Immunization Practices of the U.S. Centers for Disease Control recommended that adolescents and adults in close contact with infants get a booster of the Tdap vaccine (tetanus, diphtheria and acellular pertussis).1

Infants can’t get immunized against the flu until 6 months at the earliest. Influenza is particularly dangerous for those at both ends of the age spectrum: those over 65 years old and those under 2 years old. These groups are more likely to have severe complications, require hospitalization, and die from the illness.

This year has been especially bad for the flu, with 84 pediatric deaths already reported by February 10, with the peak of flu season still to come.2 The younger the child, the more dangerous the flu is.

How Do I Do It?

Pertussis is part of the normal childhood vaccines that everyone gets. But immunity wanes, so everyone needs boosters about every 10 years starting around 11 years old. Most women get a booster during pregnancy, and their partners are encouraged to get one before or soon after the baby is born.

But it’s up to you to remind everyone else to get a booster for pertussis and a flu shot during flu season. One way to do this is with friendly reminder email, an example of which can be found here.

Remember, anyone with a cough could have pertussis, which can be deadly in newborns. So politely but firmly ask that anyone who comes into contact with your baby to get immunized, or refrain from visiting. If they care about you and your baby, they will respect your wishes.

Does Cocooning Work?

As part of a multi-pronged strategy, the answer is, “Yes, cocooning does work.” As a single strategy by itself, the answer is, “No, not so much.”

One study in Australia showed that when mom and dad are both vaccinated, the risk of pertussis was reduced by 51%.3 The problem is, this doesn’t happen as often as it should.

A study in France after 10 years of cocooning experience revealed that only one couple out of four (26%) were both immunized against pertussis.4 Similarly, in Australia, 22% of babies were discharged to a home where neither parent was vaccinated against pertussis. This study also shows that the timing of the maternal vaccine matters:  only 26% of men were vaccinated against pertussis when the baby’s mother was vaccinated post-partum, but 83% of men were vaccinated when mom was vaccinated during pregnancy.5

And the numbers are worse when considering all the baby’s contacts, not just mom and dad.  In one study in the U.S., only 12.6% of households had all close contacts of the infant vaccinated against pertussis, while almost half (43.7%) had no Tdap-vaccinated adults at all.1

Other studies have shown that vaccinating pregnant women is much more effective at preventing pertussis than cocooning or than vaccinating the mothers post-partum.6,7

So even though cocooning can be effective, it is difficult to implement. To best protect your infant, consider all three strategies of protection:

  • Get yourself immunized against pertussis and the flu while pregnant
  • Insist on a vaccination against pertussis and the flu for your partner and anyone else who will be around the baby
  • Get the baby vaccinated when she is old enough

References:

1  Blain AE, Lewis M, Banerjee E, et al. An Assessment of the Cocooning Strategy for Preventing Infant Pertussis-United States, 2011. Clin Infect Dis. 2016 Dec 1;63 (suppl 4):S221-S6.

2  2017-2018 Influenza Season Week 5 ending February 10, 2018. 2018. (Accessed February 15, 2018, at https://www.cdc.gov/flu/weekly/index.htm#S3.)

3  Quinn HE, Snelling TL, Habig A, Chiu C, Spokes PJ, McIntyre PB. Parental Tdap boosters and infant pertussis: a case-control study. Pediatrics. 2014 Oct;134 (4):713-20.

4  Cohen R, Gaudelus J, Denis F, Stahl J-P, Chevaillier O, Pujol P, Martinot A. Pertussis vaccination coverage among French parents of infants after 10 years of cocoon strategy. Medecine et maladies infectieuses. 2016;46:188-93.

5  Krishnaswamy S, Wallace EM, Cheng AC, Buttery J, Giles ML. Protecting newborns from pertussis: The role of partner vaccination in the era of maternal immunization. Eur J Obstet Gynecol Reprod Biol. 2017 Sep;216:159-63.

6  Fernandez-Cano MI, Armadans Gil L, Campins Marti M. Cost-benefit of the introduction of new strategies for vaccination against pertussis in Spain: cocooning and pregnant vaccination strategies. Vaccine. 2015 May 5;33 (19):2213-20.

7  Carcione D, Regan AK, Tracey L, et al. The impact of parental postpartum pertussis vaccination on infection in infants: A population-based study of cocooning in Western Australia. Vaccine. 2015 Oct 13;33 (42):5654-61.

Ruben Rucoba
Dr. Rucoba has over 25 years of experience as a primary care pediatrician after completing medical school at the University of California, San Francisco. His clinical areas of expertise include caring for children with special health care needs and assisting families with international adoption. He has been a freelance medical writer since 2010, writing for health websites, continuing medical education providers, and various print outlets. He currently works at Wheaton Pediatrics in the suburbs of Chicago, where he lives with his wife and four daughters, including a set of twins.

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