Hospital Immunization Program to "Cocoon" Newborns Against Pertussis

Learning Objectives for this Presentation:
By the end of the presentation participants will be able to:
1. Define "cocooning" for newborns
2. Identify collaborative partners
3. Identify two initial steps for implementing a cocooning program

Background:
Rates of pertussis have increased dramatically in recent years with largest increases among adolescents and adults who transmit the disease to others. Although no one reason has been identified, one hypothesis is that prior immunization for pertussis (DTaP) looses effectiveness over time. The most vulnerable populations susceptible to pertussis are newborns and infants less than one year of age. While infants receive vaccinations, complete immunity is not achieved until one year of age. Research shows that the majority of infants diagnosed with pertussis were infected by close family members or healthcare providers. “Cocooning” is a concept whereby individuals in close contact with newborns (family, healthcare providers) are immunized through a pertussis booster (Tdap) to protect this vulnerable population until they develop their own immunity through regularly scheduled vaccinations.

Setting:
525 bed hospital in the Northwest United States with a delivery rate of 5,000 babies each year.

Population:
Families and healthcare providers who have direct contact with newborns participate in the cocooning program.

Project Description:
Collaboration between hospital, county health department and state health division was initiated with the goal of increasing vaccination rates to protect adolescents, adults and newborns. Initials steps included: (1) secure funding, (2) generating excitement, (3) involvement of key players (pharmacy, medical records, nursing leadership, clinicians), and (4) develop process. Implementation of the program included: (1) education, (2) communication, and (3) community “kick-off” of cocooning program.

Results/Lessons Learned:
In the 16 months since starting this program almost 8,000 doses of Tdap have been administered to healthcare providers and family members with close contact to newborns. Lessons learned: reasons for refusal, documentation issues, process changes, education, expanding the program and maintaining excitement.