Given the reluctance to vaccinate children on the part of some parents, as well as issues with efficacy of the vaccine requiring boosters to maintain herd immunity, the burden of pertussis remains a global public health issue not just in this country but around the world, especially in young infants who have not yet been vaccinated fully. To protect infants from pertussis transmission, two strategies have been proposed: (1) vaccination of pregnant women with protection through passive passage of antibodies to an infant and (2) cocooning whereby parents, caregivers, and other close contacts are vaccinated to indirectly protect infant transmission by keeping the organism out of those in close proximity to the infant.
So which strategy is better? You’ll have to read a special article by Forsyth et al. (doi: 10.1542/peds.2014-3925) who reviews the evidence for both and arrives at the conclusion that vaccination during pregnancy is the preferred way to protect infants with cocooning as the backup plan. Doctor Mark Sawyer and Doctor Sarah Long offer their own infectious disease expertise in an accompanying commentary (doi: 10.1542/peds.2015-0770) to further stress the import of making sure Tdap is given to every pregnant mother-to-be.
Take a shot at reading both the special article and commentary and in turn, don’t forget to tell pregnant mothers in your practice to get their Tdap if they haven’t already.