Lessons Learned In Implementing a Cocoon Program to Prevent Infant Pertussis at Four Kansas Hospitals

Background: 

Pertussis-related complications and deaths occur almost exclusively in infants too young to have completed the primary immunization series.  Studies have shown that in approximately 70% of infant pertussis cases where a source can be identified, the infant acquired the infection from an immediate family member.  In 2001, the Global Pertussis Initiative was implemented, with a key strategy of “cocooning” (vaccinating family members and close contacts of the newborn), and in 2006, ACIP mirrored these same recommendations.  

Setting:  Four birthing hospitals associated with three county health departments.

Population:  Postpartum women and primary caregivers of infants born in the three project counties.

Project Description:  Tdap vaccine was provided to project sites with the goal of vaccinating a postpartum woman and one designated primary caregiver (parent, grandparent, childcare provider, etc) per newborn.  A method of vaccinating the postpartum woman and caregiver was developed with each project hospital and local health department.  This strategy included standing orders at the hospital to vaccinate the postpartum woman prior to discharge, in addition to a voucher redemption program enabling the designated caregiver to receive the Tdap vaccination for little or no cost at the corresponding local health department.

Results/Lessons Learned:   Vaccination of postpartum women was deemed successful with vaccination rates above 80% during the first six months of the pilot program.  However, caregiver vaccination was not as robust, with rates below 20% during the same time period.  After further evaluation, it was determined that many barriers existed with the voucher redemption program.  At one pilot hospital, a strategy was implemented through interdepartmental collaboration allowing a caregiver to be vaccinated prior to the infant’s discharge without any additional cost to the family.  This resulted in a 200% increase in caregiver vaccination rates.