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Effectiveness of parental cocooning as a vaccination strategy to prevent pertussis infection in infants: A
Stacey L Rowe1, Ee Laine Tay1, Lucinda J Franklin1
1State Government Department of Health and Human Services, 50 Lonsdale Street, Melbourne, Victoria, Australia.
Insights
The cocoon program, where parents receive pertussis vaccines after birth, showed a potential 77% vaccine effectiveness in protecting infants. This strategy may help prevent infant pertussis when antenatal vaccination is missed.
Area of Science:
- Public Health
- Epidemiology
- Vaccinology
Background:
- A pertussis epidemic in Victoria, Australia (2009) prompted the implementation of a cocoon program.
- This program offered parents of newborns a funded pertussis-containing vaccine dose.
- The study aimed to assess the vaccine effectiveness (VE) of this program in protecting infants.
Purpose of the Study:
- To evaluate the effectiveness of the cocoon vaccination program in reducing pertussis infection among infants.
- To determine the impact of parental vaccination post-infant birth on infant pertussis rates.
Main Methods:
- A matched case-control study design was employed.
- Infants under 12 months with pertussis (cases) and healthy infants (controls) were recruited.
- Parental vaccination status and timing were assessed via telephone interviews.
Main Results:
- The study included 215 pertussis cases and 240 controls.
- Vaccination of both parents postpartum reduced infant pertussis by 77% (unadjusted VE).
- Adjusted VE was 64%, though confidence intervals were wide, indicating a lack of statistical significance.
Conclusions:
- Cocoon immunization, with both parents vaccinated postpartum, may offer protection against infant pertussis.
- This strategy could be a valuable alternative when maternal antenatal vaccination is not feasible.
- Further research may be needed to confirm the statistical significance of the observed protection.
Background:
During a pertussis epidemic in 2009, the Department of Health, Victoria, Australia, implemented a cocoon program offering parents of new babies a funded-dose of pertussis-containing vaccine. We assessed vaccine effectiveness (VE) of the program in reducing pertussis infection in infants.
Methods:
Using a matched case-control design, infants aged <12 months that were notified with pertussis between 1 January 2010 and 31 December 2011, and born during the time that the cocoon program was in place, were identified. Controls were matched by area of residence and date of birth. Telephone interviews we conducted to ascertain parents' vaccination status, and if vaccinated, timing of vaccination receipt relative to the birth of their baby. Odds ratios (ORs) were calculated for the association between vaccination and pertussis infection, with VE calculated as (1 - OR) × 100%.
Results:
The study recruited 215 cases and 240 controls (response rates 67% and 25% of eligible participants, respectively). Vaccination of both parents after delivery of the infant and ≥28 days prior to illness onset reduced pertussis infection by 77% (Vaccine Effectiveness [VE] = 77% (confidence interval [95% CI], 18-93%). After adjusting for maternal education, presence of a sibling within the household, and the infants' primary course vaccination status, the adjusted VE was 64% (95% CI, -58-92%).
Conclusions:
Although not reaching statistical significance, our results demonstrated that cocoon immunisation - where both parents are vaccinated in the post-partum period - may offer some protection again infant pertussis infection. Cocoon immunisation could be considered in circumstances where antenatal vaccination of the mother has not occurred.
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