Cocooning: Doctors Divided on Vaccine Strategy to Protect Babies

Giving vaccines to close family members of babies too young to get shots themselves is one protection strategy, but some worry about cost.

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A large group of U.S. doctors on Monday gave the green light for pediatricians to offer vaccines to close family members of babies who are too young to get shots themselves. The strategy, known as cocooning, is meant to block diseases from reaching the infant in the first place and is backed by the U.S. Centers for Disease Control and Prevention.

But earlier this month, Canadian government researchers suggested that at least for whooping cough, a major infectious disease worldwide, cocooning comes with a hefty price tag. They estimated that to prevent one infant death from the disease in Quebec or British Columbia, at least one million parents would have to be vaccinated -- at a cost of some 20 Canadian dollars per shot.

To prevent one baby from being hospitalized, between 10,000 and 20,000 people would need to be vaccinated.

"This program appears inefficient," said Dr. Danuta Skowronski, of the British Columbia Center for Disease Control in Vancouver. "In fact, the criteria for this to be successful are almost impossible," she told Reuters Health. "We're not saying that babies are not important -- of course they are -- but we have to be wise about how we use our finite resources."

The new American Academy of Pediatrics' report on cocooning, released in the journal Pediatrics, is not directly recommending that pediatricians start offering parents shots -- a practice that has been controversial. "What it says is, if you choose to do it, this is OK," said the AAP's Dr. Herschel R. Lessin, who worked on the report. "They give flu shots in airports and pharmacies. There is really no reason why a licensed doctor can't give them also."

SHIELDING THE BABY

Lessin said the main focus is on flu shots and the TDaP vaccine, which protects against tetanus, diphtheria, and whooping cough (pertussis). There is already a national U.S. mandate to give these vaccines to everybody, he added, including pregnant women. But babies have to be at least six weeks old to get the TDaP vaccine and six months old to get a flu shot.

In the meantime, their only protection is through antibodies they get from their mother in the womb and in breast milk if she has been vaccinated or has natural immunity against the infections.

Lessin said that because not all pregnant women get vaccinated, cocooning is still a reasonable strategy to shield infants.

People with whooping cough typically cough uncontrollably and may have trouble breathing. The disease is especially dangerous for newborns, whose immune systems are still not fully mature. According to the CDC, more than half of babies under one year who get whooping cough need to go to the hospital. While rates of the infection have dropped fast over the past half century, they have begun to climb again over the past few years. About one in 1,000 U.S. infants caught the pertussis bug last year, the CDC says, although these are only the reported cases.

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Andrew Seaman is a reporter for Reuters.

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