Cocooning (immunization)

Last updated
Children generally have close contact with their parents, so children often catch diseases from their parents. This mother's vaccination therefore reduces the risk of infection for the child on her lap. Patients receive flu vaccination at Naval Health Clinic Hawaii 151001-N-GI544-080.jpg
Children generally have close contact with their parents, so children often catch diseases from their parents. This mother's vaccination therefore reduces the risk of infection for the child on her lap.

Cocooning, also known as the Cocoon Strategy, [1] is a vaccination strategy to protect infants and other vulnerable individuals from infectious diseases by vaccinating those in close contact with them. If the people most likely to transmit an infection are immune, their immunity creates a "cocoon" of protection around the newborn (or other vulnerable person).[ citation needed ]

Contents

Cocooning is especially commonly used for pertussis. It aims to protect newborn infants from becoming infected with pertussis by administering DTaP/Tdap (tetanus, diphtheria and acellular pertussis) booster vaccine to parents, family members and any individuals who would come into regular contact with the newborn infant. By vaccinating these individuals with a pertussis booster, a pool of persons is established around the newborn who are themselves protected from getting pertussis and passing it on to the infant, thereby creating a "cocoon" of protection around the newborn. Young infants have the highest rate of pertussis; in 87-100% of all deaths caused by pertussis, the victim is an infant of less than 6 months of age, too young to have finished acquiring vaccine-induced immunity. Adolescents and young adults whose immunity has just worn off are often infected, but very unlikely to die. They can, however, infect others. [1] [2] [3] [4] 35% to 68% of infants infected with pertussis are infected by a close contact, most commonly the mother. Cocooning prevents about 20% of infant pertussis cases; vaccination during pregnancy prevents more (33%). [4]

Rationale

A newborn has very little immunity to viruses HumanNewborn.JPG
A newborn has very little immunity to viruses

Some people cannot be fully protected from vaccine-preventable diseases by direct vaccination. These are often people with weak immune systems, who are more likely to get seriously ill. Their risk of infection can be significantly reduced if those who are most likely to infect them get the appropriate vaccines.[ citation needed ]

Vaccination works by training the immune system to react promptly to an infection, warding off illness (acquired immunity). People with weak immune systems may have difficulty acquiring and retaining immunity.[ medical citation needed ]

A baby's immune system is not yet fully developed. Babies are more likely to have serious complications or die from diseases, even diseases that have milder effects in adults. [3] [5] A baby can use some antibodies from the mother, transmitted in the womb. For this reason, it is recommended that people who are expecting to become pregnant get some vaccines, and those who are pregnant get others. [6] [3] [5] However, this maternal protection wears off after a few months. [3] [5] Breastfeeding also offers protection, but is not as effective as vaccination at preventing some diseases. [3]

Some people have compromised immune systems. The immune system can be compromised by congenital medical conditions, infectious diseases, non-infectious conditions such as cancer, and immunosuppressive medications or treatments (for instance, people with organ transplants take drugs to prevent their immune system from killing the transplant). People who are severely immuno-compromised may not be able to take some vaccines; on the other hand, they may be much more severely affected by an infection. [7] [6] [8] If the people they share a house with are immune, this provides them with significant protection. They benefit when their housemates get all the recommended inactivated vaccines. They also benefit if their housemates get many attenuated vaccines. However, some attenuated vaccines are not recommended for people living with immuno-compromised people, depending on the vaccine and cause of immune suppression. [6]

Some vaccines require multiple doses, spaced over time, to be effective. Those who have not yet received all the doses (including all young babies) are not yet fully immune, and rely on the immunity of those around them. [9] Some vaccines also require booster doses in later life; those who have not received their booster doses can be infected and infect others. [1]

Some people are also unable to take some vaccines due to an allergic reaction. [10]

Recommendations and use

Cocooning is widely recommended. [4] Cocooning for pertussis has been recommended by the Centers for Disease Control and Prevention (CDC) in the United States since 2006. [11] The World Health Organization, the US Centers for Disease Control and Prevention (CDC), the Global Pertussis Initiative, and the Public Health Agency of Canada all recommend cocooning against pertussis. [4] The Advisory Committee on Immunization Practices (ACIP) has recommended cocooning with Tdap vaccine since 2005 and has continued to recommend this strategy for all those with expected close contact with infants. ACIP states that cocooning provides maximum protection to the infant beyond what is provided by maternal vaccination. ACIP is recommending that all relatives and caregivers get vaccinated against pertussis at least two weeks before coming into contact with infants. [11] While acceptance of cocooning is high, implementation in not yet widespread as of 2012. [12]

See also

Related Research Articles

<span class="mw-page-title-main">Vaccination</span> Administration of a vaccine to protect against disease

Vaccination is the administration of a vaccine to help the immune system develop immunity from a disease. Vaccines contain a microorganism or virus in a weakened, live or killed state, or proteins or toxins from the organism. In stimulating the body's adaptive immunity, they help prevent sickness from an infectious disease. When a sufficiently large percentage of a population has been vaccinated, herd immunity results. Herd immunity protects those who may be immunocompromised and cannot get a vaccine because even a weakened version would harm them. The effectiveness of vaccination has been widely studied and verified. Vaccination is the most effective method of preventing infectious diseases; widespread immunity due to vaccination is largely responsible for the worldwide eradication of smallpox and the elimination of diseases such as polio and tetanus from much of the world. However, some diseases, such as measles outbreaks in America, have seen rising cases due to relatively low vaccination rates in the 2010s – attributed, in part, to vaccine hesitancy. According to the World Health Organization, vaccination prevents 3.5–5 million deaths per year.

<span class="mw-page-title-main">Vaccine</span> Pathogen-derived preparation that provides acquired immunity to an infectious disease

A vaccine is a biological preparation that provides active acquired immunity to a particular infectious or malignant disease. The safety and effectiveness of vaccines has been widely studied and verified. A vaccine typically contains an agent that resembles a disease-causing microorganism and is often made from weakened or killed forms of the microbe, its toxins, or one of its surface proteins. The agent stimulates the body's immune system to recognize the agent as a threat, destroy it, and recognize further and destroy any of the microorganisms associated with that agent that it may encounter in the future.

<span class="mw-page-title-main">Herd immunity</span> Concept in epidemiology

Herd immunity is a form of indirect protection that applies only to contagious diseases. It occurs when a sufficient percentage of a population has become immune to an infection, whether through previous infections or vaccination, thereby reducing the likelihood of infection for individuals who lack immunity.

<span class="mw-page-title-main">Whooping cough</span> Human disease caused by the bacteria Bordetella pertussis

Whooping cough, also known as pertussis or the 100-day cough, is a highly contagious, vaccine-preventable bacterial disease. Initial symptoms are usually similar to those of the common cold with a runny nose, fever, and mild cough, but these are followed by two or three months of severe coughing fits. Following a fit of coughing, a high-pitched whoop sound or gasp may occur as the person breathes in. The violent coughing may last for 10 or more weeks, hence the phrase "100-day cough". The cough may be so hard that it causes vomiting, rib fractures, and fatigue. Children less than one year old may have little or no cough and instead have periods where they cannot breathe. The incubation period is usually seven to ten days. Disease may occur in those who have been vaccinated, but symptoms are typically milder.

<span class="mw-page-title-main">DPT vaccine</span> Combination vaccine

The DPT vaccine or DTP vaccine is a class of combination vaccines against three infectious diseases in humans: diphtheria, pertussis, and tetanus (lockjaw). The vaccine components include diphtheria and tetanus toxoids, and either killed whole cells of the bacterium that causes pertussis or pertussis antigens. The term toxoid refers to vaccines which use an inactivated toxin produced by the pathogen which they are targeted against to generate an immune response. In this way, the toxoid vaccine generates an immune response which is targeted against the toxin which is produced by the pathogen and causes disease, rather than a vaccine which is targeted against the pathogen itself. The whole cells or antigens will be depicted as either "DTwP" or "DTaP", where the lower-case "w" indicates whole-cell inactivated pertussis and the lower-case "a" stands for "acellular". In comparison to alternative vaccine types, such as live attenuated vaccines, the DTP vaccine does not contain any live pathogen, but rather uses inactivated toxoid to generate an immune response; therefore, there is not a risk of use in populations that are immune compromised since there is not any known risk of causing the disease itself. As a result, the DTP vaccine is considered a safe vaccine to use in anyone and it generates a much more targeted immune response specific for the pathogen of interest.

<span class="mw-page-title-main">Vaccination schedule</span> Series of vaccinations

A vaccination schedule is a series of vaccinations, including the timing of all doses, which may be either recommended or compulsory, depending on the country of residence. A vaccine is an antigenic preparation used to produce active immunity to a disease, in order to prevent or reduce the effects of infection by any natural or "wild" pathogen. Vaccines go through multiple phases of trials to ensure safety and effectiveness.

<span class="mw-page-title-main">Childhood immunizations in the United States</span>

The schedule for childhood immunizations in the United States is published by the Centers for Disease Control and Prevention (CDC). The vaccination schedule is broken down by age: birth to six years of age, seven to eighteen, and adults nineteen and older. Childhood immunizations are key in preventing diseases with epidemic potential.

<span class="mw-page-title-main">Booster dose</span> Additional administration of vaccine

A booster dose is an extra administration of a vaccine after an earlier (primer) dose. After initial immunization, a booster provides a re-exposure to the immunizing antigen. It is intended to increase immunity against that antigen back to protective levels after memory against that antigen has declined through time. For example, tetanus shot boosters are often recommended every 10 years, by which point memory cells specific against tetanus lose their function or undergo apoptosis.

In immunology, passive immunity is the transfer of active humoral immunity of ready-made antibodies. Passive immunity can occur naturally, when maternal antibodies are transferred to the fetus through the placenta, and it can also be induced artificially, when high levels of antibodies specific to a pathogen or toxin are transferred to non-immune persons through blood products that contain antibodies, such as in immunoglobulin therapy or antiserum therapy. Passive immunization is used when there is a high risk of infection and insufficient time for the body to develop its own immune response, or to reduce the symptoms of ongoing or immunosuppressive diseases. Passive immunization can be provided when people cannot synthesize antibodies, and when they have been exposed to a disease that they do not have immunity against.

A breakthrough infection is a case of illness in which a vaccinated individual becomes infected with the illness, because the vaccine has failed to provide complete immunity against the pathogen. Breakthrough infections have been identified in individuals immunized against a variety of diseases including mumps, varicella (Chickenpox), influenza, and COVID-19. The characteristics of the breakthrough infection are dependent on the virus itself. Often, infection of the vaccinated individual results in milder symptoms and shorter duration than if the infection were contracted naturally.

<span class="mw-page-title-main">Varicella vaccine</span> Vaccine to prevent chickenpox

Varicella vaccine, also known as chickenpox vaccine, is a vaccine that protects against chickenpox. One dose of vaccine prevents 95% of moderate disease and 100% of severe disease. Two doses of vaccine are more effective than one. If given to those who are not immune within five days of exposure to chickenpox it prevents most cases of disease. Vaccinating a large portion of the population also protects those who are not vaccinated. It is given by injection just under the skin. Another vaccine, known as zoster vaccine, is used to prevent diseases caused by the same virus – the varicella zoster virus.

<span class="mw-page-title-main">Hepatitis B vaccine</span> Vaccine against hepatitis B

Hepatitis B vaccine is a vaccine that prevents hepatitis B. The first dose is recommended within 24 hours of birth with either two or three more doses given after that. This includes those with poor immune function such as from HIV/AIDS and those born premature. It is also recommended that health-care workers be vaccinated. In healthy people, routine immunization results in more than 95% of people being protected.

<span class="mw-page-title-main">Hib vaccine</span> Haemophilus influenzae type B vaccine

The Haemophilus influenzae type B vaccine, also known as Hib vaccine, is a vaccine used to prevent Haemophilus influenzae type b (Hib) infection. In countries that include it as a routine vaccine, rates of severe Hib infections have decreased more than 90%. It has therefore resulted in a decrease in the rate of meningitis, pneumonia, and epiglottitis.

<span class="mw-page-title-main">Diphtheria vaccine</span> Vaccine against diphtheria

Diphtheria vaccine is a toxoid vaccine against diphtheria, an illness caused by Corynebacterium diphtheriae. Its use has resulted in a more than 90% decrease in number of cases globally between 1980 and 2000. The first dose is recommended at six weeks of age with two additional doses four weeks apart, after which it is about 95% effective during childhood. Three further doses are recommended during childhood. It is unclear if further doses later in life are needed.

<span class="mw-page-title-main">Pertussis vaccine</span> Vaccine protecting against whooping cough

Pertussis vaccine is a vaccine that protects against whooping cough (pertussis). There are two main types: whole-cell vaccines and acellular vaccines. The whole-cell vaccine is about 78% effective while the acellular vaccine is 71–85% effective. The effectiveness of the vaccines appears to decrease by between 2 and 10% per year after vaccination with a more rapid decrease with the acellular vaccines. The vaccine is only available in combination with tetanus and diphtheria vaccines. Pertussis vaccine is estimated to have saved over 500,000 lives in 2002.

Meningococcal vaccine refers to any vaccine used to prevent infection by Neisseria meningitidis. Different versions are effective against some or all of the following types of meningococcus: A, B, C, W-135, and Y. The vaccines are between 85 and 100% effective for at least two years. They result in a decrease in meningitis and sepsis among populations where they are widely used. They are given either by injection into a muscle or just under the skin.

<span class="mw-page-title-main">Yellow fever vaccine</span> Vaccine that protects against yellow fever

Yellow fever vaccine is a vaccine that protects against yellow fever. Yellow fever is a viral infection that occurs in Africa and South America. Most people begin to develop immunity within ten days of vaccination and 99% are protected within one month, and this appears to be lifelong. The vaccine can be used to control outbreaks of disease. It is given either by injection into a muscle or just under the skin.

<span class="mw-page-title-main">Tetanus vaccine</span> Vaccines used to prevent tetanus

Tetanus vaccine, also known as tetanus toxoid (TT), is a toxoid vaccine used to prevent tetanus. During childhood, five doses are recommended, with a sixth given during adolescence.

<span class="mw-page-title-main">Ring vaccination</span> Strategy to inhibit the spread of a disease by vaccinating those most likely to be infected

Ring vaccination is a strategy to inhibit the spread of a disease by vaccinating those who are most likely to be infected.

DTaP-IPV-HepB vaccine is a combination vaccine whose generic name is diphtheria and tetanus toxoids and acellular pertussis adsorbed, hepatitis B (recombinant) and inactivated polio vaccine or DTaP-IPV-Hep B. It protects against the infectious diseases diphtheria, tetanus, pertussis, poliomyelitis, and hepatitis B.

References

  1. 1 2 3 Healy, C. M.; Rench, M. A.; Baker, C. J. (2010). "Implementation of Cocooning against Pertussis in a High-Risk Population". Clinical Infectious Diseases. 52 (2): 157–162. doi:10.1093/cid/ciq001. PMID   21288837.
  2. ↑ Campins, Magda; Moreno-Pérez, David; Gil-de Miguel, Angel; González-Romo, Fernando; Moraga-Llop, Fernando A.; Arístegui-Fernández, Javier; Goncé-Mellgren, Anna; Bayas, José M.; Salleras-Sanmartí, Lluís (2013). "[Whooping cough in Spain. Current epidemiology, prevention and control strategies. Recommendations by the Pertussis Working Group]". Enfermedades Infecciosas y Microbiologia Clinica. 31 (4): 240–253. doi:10.1016/j.eimc.2012.12.011. ISSN   1578-1852. PMID   23411362.
  3. 1 2 3 4 5 "Ultimate Babyproofing Plan | Parents | Vaccines | CDC". www.cdc.gov. US Centers for Disease Control. 6 December 2018. Retrieved 19 May 2019.
  4. 1 2 3 4 Gilley, M; Goldman, RD (February 2014). "Protecting infants from pertussis". Canadian Family Physician. 60 (2): 138–40. PMC   3922557 . PMID   24522676.
  5. 1 2 3 "Vaccine-Preventable Disease Tile Infographics | CDC". www.cdc.gov. US Centers for Disease Control. 6 December 2018.
  6. 1 2 3 Kang, Insoo; Keyserling, Harry; Sung, Lillian; Dhanireddy, Shireesha; Bousvaros, Athos; Tomblyn, Marcie; Avery, Robin; Davies, E. Graham; Ljungman, Per; Levin, Myron J.; Rubin, Lorry G. (1 February 2014). "2013 IDSA Clinical Practice Guideline for Vaccination of the Immunocompromised Host". Clinical Infectious Diseases. 58 (3): e44–e100. doi:10.1093/cid/cit684. ISSN   1058-4838. PMID   24311479.
  7. ↑ "MODULE 2 – Immunizing the immunocompromised - WHO Vaccine Safety Basics". vaccine-safety-training.org. World Health Organization. Retrieved 19 May 2019.
  8. ↑ "Vaccination of Persons with Primary and Secondary Immune Deficiencie" (PDF). US Centers for Disease Control. Retrieved 19 May 2019.
  9. ↑ "Cocooning Protects Babies" (PDF). Archived from the original (PDF) on 2020-01-02. Retrieved 2019-05-19.
  10. ↑ "Tabelle - Contraindications to vaccines - WHO Vaccine Safety Basics". vaccine-safety-training.org. World Health Organization. Retrieved 19 May 2019.
  11. 1 2 "Cocooning". Centers for Disease Control and Prevention. Retrieved 2012-09-30.
  12. ↑ Grizas, Alexandra P.; Camenga, Deepa; Vázquez, Marietta (2012). "Cocooning: a concept to protect young children from infectious diseases". Current Opinion in Pediatrics. 24 (1): 92–97. doi:10.1097/MOP.0b013e32834e8fe9. ISSN   1531-698X. PMID   22157361. S2CID   27726049.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.