This week, Washington State declared that whooping cough (pertussis) has reached epidemic levels. Since the beginning of the year, we’ve had more than 600 documented cases in the state, a dramatic increase since last year. The increase puts our new babies at risk.
In clinic I’ve been urging new parents to cocoon their babies. That is, provide a family of protection by having every single child & adult immunized against whooping cough, influenza, and other vaccine preventable illnesses. By surrounding a baby with only immunized people, you cocoon them against serious infections.
Whooping cough is a highly infectious respiratory illness spread by sneezing and coughing that can be deadly to young infants. Getting a Tdap shot is the best way to avoid getting whooping cough. Amidst an epidemic, we worry most about newborns because they are most vulnerable to complications and lack vaccine-protection. If every child and adult that surrounds a newborn gets a Tdap shot, the likelihood of the baby getting whooping cough approaches zero.
Most newborns get whooping cough from their family or adults around them. That’s where an email comes to play.
You’re going to have to be fairly Mama-Papa-Bear about this. You’ll have to show some strength to create a very safe home, even when it feels somewhat over-the-top. As I said to a number of families in clinic today, “It only seems entirely over-the-top-nuts until we lose another newborn to pertussis.” Being smart now will save lives.
Make a new rule: no visits with a newborn until all visitors have had the Tdap shot. Even Grandparents.
Write an email to family and friends to explain.
A sample email for you to use/copy/share –written today by a friend of mine–mother to that darling baby girl born last week:
Hi there,
We are hoping we get to see you and introduce you to our new baby sometime
in the next few months!
Due to the pertussis epidemic around here and the fact that flu
incidence is peaking, I am being a stickler about only having visitors
who have had the flu shot and Tdap vaccine. We just got back from our
doctor who emphasized how important this is as both – esp pertussis –
are very serious for infants. A Tdap shot should be completed 2 weeks
before hanging out with a newborn.
You can get both at your doctor’s office and at many pharmacies that
do vaccines. Thanks for understanding!
- CDC info on Pertussis
- Washington State and Pertussis
More Information on Whooping Cough:
- What is the Tdap shot? Quick video summary about the shot. Here’s the blog post about the Tdap shot.
- All children, teens, and adults need a Tdap now. Grandparents around newborns need a Tdap now.
- Ideally, get the Tdap shot 2 weeks prior to visiting with a newborn. Same is true for a flu shot.
- Current data in Washington state on number of positive cases, counties involved, and information on surpassing the epidemic threshold.
- Wash your hands, cover your cough, and don’t visit a newborn while sick even if you’ve had a Tdap shot!
Meagan says
At what point is it safe to have babies around unvaccinated adults and children? My baby’s first birthday party is coming up, and I’d hoped to invite a couple friends with younger infants. We also have a close friend who doesn’t vaccinate, with two little ones (young baby and 3 1/2 year old). I’d hate to have to chose between them, but I don’t want to put anyone’s baby at risk.
Wendy Sue Swanson, MD says
Meagan,
You ask a great question that unfortunately has no clear answer. In regards to whooping cough, infants are at highest risk under 6 months of age, and MOST risk under 2 months of age.
By 6 months of age, a baby’s immune system is nearly mature and as they start to explore their world more by bringing EVERYTHING into their mouth they get much more exposure to infection. Continuing the cocoon as long as possible a great (but impractical) goal.
If I had to come down on a rule I’d say, you want to cocooon as long as possible, but I’d be more comfortable exposing a baby to more risk after 3-6 months of age.
Laura says
I sent an e-mail like that and included an FAQ at the bottom. The PCP for many of my family members had given the Td vaccine as recently as 2008:( so there was a lot of confusion about what shot they had and what to do about it.
Q) What if my doctor gave me the Td vaccine (without the Pertussis component) instead of the Tdap vaccine?
A) The Tdap was approved for adult use in 2005. Unfortunately, some doctors don’t keep up with new vaccine recommendations (and maybe had old Td vaccines to unload), so some people might have been given the Td instead at their last vaccination. If it has been more than seven years, you most certainly got the Td vaccine instead. Please check with your doctor if you are not positive! Luckily/unluckily, you may get a Tdap at any time after getting the Td shot.
Q) Am I too old for this vaccine?
A) No, dad, you’re not. They have recently updated their guidance for those over 65.
Q) Where can I get this vaccine?
A) Obviously, your doctor’s office. However, many pharmacies offer this shot as well and don’t require an appointment.
Q) When should I get the shot?
A) As soon as possible! It takes about two weeks to mount an immune response to the vaccine. So ideally, two to four weeks before you meet our little one.
Q) What happens if I don’t get the vaccine?
A) We won’t be your friend anymore. Just kidding. Kind of. But we won’t let you near our baby. Sorry!
Joy says
At what age can we let our new baby “out of the cocoon”? Thank you for this post and for the sample email to send to family & friends.
Wendy Sue Swanson, MD says
Hi Joy,
The coccoon answer is above.
After 3 months of age, an infant as high-risk for infection spread and with each fever don’t always need a work-up, so the strict cocoon–I say it ends around 3 months of age.
Good hand-washing, keeping sick visitors away is always a goal though. Great thing is, babies have wonderful immune systmes and breastfeeding provides even more immune protection.
Julie says
Hi, if you have a 10 year old should they get an early boost of the vaccine? I do know a few kids that did get it despite being vaccinated. One was just 25 days away from getting his boost. Better to do sooner rather than later? Are all adults that work with kids as preschools and schools required to have their boost? It would seem this shoudl be a priority if they are going to be around kids.
Wendy Sue Swanson, MD says
It is currently not recommended that your 10 year old get the Tdap if they are otherwise up to date (got all 4 DTAP at 2,4 6, and 15 months of age). Here’s a link for more info from the CDC and an excerpt I’m pasting here:
https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6001a4.htm?s_cid=mm6001a4_w
Guidance for use. ACIP recommends that children aged 7 through 10 years who are not fully vaccinated* against pertussis and for whom no contraindication to pertussis vaccine exists should receive a single dose of Tdap to provide protection against pertussis. If additional doses of tetanus and diphtheria toxoid–containing vaccines are needed, then children aged 7 through10 years should be vaccinated according to catch-up guidance, with Tdap preferred as the first dose (5). Tdap is recommended in this age group because of its reduced antigen content compared with DTaP, resulting in reduced reactogenicity. Currently, Tdap is recommended only for a single dose across all age groups. Further guidance will be forthcoming on timing of revaccination in persons who have received Tdap previously.
Katie says
Does this current situation change your recommendations on flying with infants, at least until the epidemic settles down?
I will have to return to work at 8 weeks post partum and there will be occasional travel. While all of our family are already vaccinated, many people on planes won’t be. Do you think it’s better to leave the baby at home or still okay to bring him with?
Claire says
I have another coccooning question…how about taking a new babe with you to appointments or sibling lessons? These are times and places where it is harder to ask a teacher or practitioner if they are immunized. Or in places where there are multiple families or kids (like to a soccer or music class)? Is it better to try to make arrangements to leave the babe elsewhere if at all possible? And what about going to a restaurant or coffee shop?
I know there is not right answer, but I would love your thoughts on how careful to be!
ClaIre says
And yet another question….if someone is visiting in a week, is it still useful to get vaccinated – even if they can’t do it two weeks ahead?
AKbear says
You have DESTROYED relationships with all this fear mongering!
Did a pharmaceutical company PAY YOU to write this crap!?!
ANSWER THAT IN A PUBLIC STATEMENY!!
It’s a wonder any infant has survived through all previous generations with Duce a dire threat hanging over babies heads!!
you are all hypocrites!!
You purport that vaccines are so beneficial and yet even with vaccinations, babies have gotten I’ll!
You are nothing but a wind bag of hot air, most likely takin in money from BigPharma!
Destroying peons relationships over this insanity… You deserve to ROT IN HELL!!!!!!
M Brinton says
Until you watch a baby die of pertussis in a PICU, you probably shouldn’t be speaking so harshly. If a grandparent is offended to the point that their relationship with their daughter/son and grandchild is destroyed over something like this, they have much bigger issues they need to work out.
Angela says
Wow, really!?
Did or do you take money from any pharmaceutical companies?
Wendy Sue Swanson, MD, MBE says
Nope. None.
VICTOR says
have you ever looked into other information…is BigPharma paying you to publish this rubbish which is destroying family relationships!?!?
telling Grandparents to stay away is fear mongering you should be utterly ashamed of yourself.
Instead of just talking about how many babies dies…how many did NOT die!!??!?!
what is the percentage rate in al of WA births???
https://www.vaccinenation.net/articles.php
Rachel says
Thanks so much for this information and the helpful email. It’s so hard to get friends an family to understand that newborns need special consideration because of their size and lack of immunity. I just read Brody’s story at https://shotofprevention.com/2012/04/25/bradys-battle-with-pertussis, and it is absolutely devastating. If people can’t wait to meet your newborn until they have had their shots or are no longer unwell, they are more concerned with their own needs and feelings than the health of your family and should be treated accordingly.
Theresa says
Should an adult that had the Whooping cough as a child be vaccinated against pertussis?
Wendy Sue Swanson, MD, MBE says
Yes.
Immunity wears off after natural infection somewhere between 4 and 20 years.
Immunity wears off after immunization somewhere between 3 and 12 years.
Everyone over age 11 needs a Tdap.
Melissa says
Hi,
I am an overly anxious mom who has had a productive cough for the last 6 days, and worse at night. I am fully vaccinated as is the rest of my family, and we are unaware of any exposure to pertussis. Regardless, I have a 3 week old baby, and I am extremely nervous that I am exposing her to something. When do pertussis symptoms present in a newborn?
Wendy Sue Swanson, MD, MBE says
Hi Melissa,
Congratulations on your baby! So sorry you’re feeling anxious.
I recommend you go in and see your clinician and have them test you for pertussis (they’ll need to do “a PCR”) and put you at ease. If there is concern you have pertussis, they can advise you about what to do for your infant. If your infant comes down with cold symptoms, go and see the the pediatrician to discuss testing.
Here’s a great link for you to read about pertussis, transmission and timing.
https://www.cdc.gov/pertussis/about/causes-transmission.html
Nell says
I understand the premise behind this philosophy.
However, I offer sincere a warning born out of personal experience–as one who was not allowed to meet my own sister’s children for six months. I am unable to get the vaccines due to a rare medical condition that specifically prohibits them. I am not diametrically opposed to vaccines. My own children are completely vaccinated per the CDC schedule.
My sister and her husband embraced cocooning fully, just as your article suggests–to the point where she prohibited me from meeting her children, through no fault of my own. We live very near each other and are (were) extremely close. As the more experienced mother, I intended to offer support, encouragement, and all the love I could give. Instead, she completely isolated herself from me and a large part of her support system. This alone is a huge breeding ground for postpartum depression, which adds yet another set of risks to the new child. But I digress…
Without going into too much detail, it tore our relationship apart. To say to someone, “You aren’t good enough the way you are to be in my child’s life right now,” is a slap in the face. I realize from a completely medical, logical, unemotional stance, cocooning makes perfect sense. I understand how new mothers believe anyone unwilling or unable to comply are being “selfish.” Please know that, as someone who has been sick much of my life, I DO get it.
And yet, we are humans. We are not robots. We have feelings. And this kind of requirement, quite honestly, is the most painful thing my sister has ever done to me. Yes, protecting our children from unnecessary risks is important. Yes, pertussis is a very real, deadly threat. Yes, as relatives we should take whatever steps are necessary to reduce those risks.
But the need to connect, to share, to embrace one another–finding a middle ground that surely exists for those unable or unwilling to be vaccinated–is, I would say, just as critical. Doctors are experts are treating our physical bodies. But they need to remember, as they advise their patients, how to teach them to find compromises to this especially sensitive issue, and to the importance of human interaction as well.
My sister and I have done our best to repair the damage done. But I suspect, unfortunately, our relationship will never be the same. And the relationships I might have had with her children have suffered as well.
Karen Crisalli Winter says
Cocooning doesn’t work for pertussis. Vaccinated people can still catch, carry, and spread pertussis. They just don’t get very sick. The overconfidence in this vaccine has caused at least one death that I know of, probably several more. Assumptions that “it can’t be pertussis, I’ve vaccinated” can delay proper treatment until it’s too late. Here is a more useful, science-based, approach to keeping pertussis away from newborns.
Keep all coughs away from newborns. Doesn’t matter if you’re vaccinated or not. Doesn’t matter if you’re real sure that it’s just a smoker’s cough or allergies or asthma. Keep all coughs away from newborns. (Obviously you’ll have to fudge on this a bit if an immediate family member is coughing, especially a parent.)
If a person with close contact with a newborn (parent, sibling) has been coughing for more than a week, get tested for pertussis.
If an infant under 6 months of age develops a cough or any breathing difficulties, rule out pertussis first. Rule it out based on testing and symptoms, not on vaccination status or known contacts. If the infant is under 2 months of age, discuss the risks and benefits of treating the cough presumptively with antibiotics. When you’re talking about an newborn, early treatment saves lives.
The whole-cell vaccine offered some community benefit. The acellular vaccine offers protection to the recipient, but doesn’t prevent colonization or transmission.
Lynn says
Karen and Nell, thank you so much for your posts. I’m currently experiencing a situation similar to Nell’s. The only difference is that I don’t have a medical condition. I’m choosing not to get vaccinated, primarily because I can’t find any evidence showing that the vaccine prevents the spread of the disease. If you Google the words “pertussis vaccine spread” the first two websites that show up are from the FDA and CDC. Both site a study that suggests the vaccine does nothing to prevent transmission of the disease – it only lessons the symptoms for those who do get exposed to pertussis.
So my question is somewhat related to Karen’s paragraph regarding overconfidence in the vaccine: if anyone, vaccinated or not, can be infected with pertussis bacteria, not even be aware of it thanks to few or no symptoms, harbor it for up to six weeks, and potentially spread it to others, including their own baby, how is an unvaccinated person more dangerous than a vaccinated one?
In fact, one could argue that an unvaccinated person is even less of a threat than a vaccinated person because at least if the unvaxed caught the pertussis bacteria, she would be more likely to exhibit symptoms that would clue her in to the infection and tell her to stay away from other people, especially babies.
So it would appear that every one of us, vaccinated or not, has the potential to spread pertussis to babies. If there’s something I’m missing here, someone please enlighten me. This is tearing our family apart.
My sister and brother-in-law’s pediatrician advised them to keep their baby away from unvaccinated people for an entire year. My father and I are not about to run out and get jabbed with something that doesn’t even prevent transmission of pertussis. Yet preventing transmission of pertussis is the only reason they “require” people to get the vaccine before even being in the same house as the baby. It makes zero sense.
I wish I could speak with their doctor and ask about this recommendation to exclude now-formerly-close family members for an entire year, and whether it was based on current research (I’d love to see it, because I can’t find any that supports her recommendation) vs. medical dogma. What ever happened to using common sense and simply keeping sick people away? As Karen put it, how about a useful, science-based approach – keep all coughs (vaccinated or not) away from newborns.
It will be a fine day when doctors stop spewing baseless recommendations in the media without any regard as to how their advice might actually affect family relations. To Dr. Swanson’s credit, her article is a few years old and may have been published prior to the study I mentioned. If that is the case, then perhaps she should update this site to reflect the most current scientific findings. Doing so may prevent other people from being needlessly ostracized over lack of a useless vaccination.
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Judy Burk says
Since when did we start vaccinating pregnant women? Has this been safety tested?
Wendy Sue Swanson, MD, MBE says
Pregnant moms are high-risk for some infections so are priorities when it comes to vaccines — take influenza, for example. Pregnant moms are more likely to get and die from influenza so we protect them with the vaccine.
Pregnant moms have been getting Tdap to provide them (and their newborns) protection since 2011. This was started, in part, because of the large (and deadly) 2010 California outbreak and the learning that we could prevent moms from getting (and giving) pertussis to their newborns.
Here’s the official 2011 update on vaccine recommendations for whooping cough:
https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6041a4.htm
Barbara says
I’m curious, Wendy Swanson, why you don’t address the concerns of those who brought up legitimate concerns, like Lynn and Karen and Nell. You simply ignore the comments that don’t go with the general CDC – vaccinate all, vaccinate often – line. You mention contraindications, but exactly what are those? Do you inform your patients of the full list of ingredients in a vaccine? Do you inform them – informed consent – of the potential for serious side effects? I think the pharmaceutical companies actually fulfill their duties – it’s the doctors who mislead s f withhold the information. Would you recommend all of the one-size fits all vaccine program if YOU were held responsible for injuries? Your concern stops as the patient or family leaves the door. You have read the reports so I know you understand that studies have shown that those who get the Whooping cough vaccine can become asymptomatic carriers and actually infect those they come into contact with. I know that you understand that most of the outbreaks have been solely in the vaccinated population. So what do you get out of this?
Wendy Sue Swanson, MD, MBE says
Hi Barbara,
Thanks for your comment and for your curiosity. Cocooning data (the data that supports immunizing a family around a baby to protect them) has, in the last few years, played second fiddle to data that early vaccination (at 6 weeks) with DTaP for babies, and vaccination with TdaP for moms during their third trimester in protecting babies. Translation: cocooning isn’t the best way to prevent whooping cough in newborns, vaccinating moms and babies as early as possible IS. I’ve written about it in more recent posts. As I think you are aware, we’re learning more about how the acellular vaccine against whooping cough doesn’t produce lifelong immunity and sometimes doesn’t provide protection in all. Typically we think about 80% of those vaccinated who get it to be protected. That’s certainly not 100%.
I don’t, in a 15-minute visit, where I’m tasked with an entire well child exam have the opportunity to review ALL the ingredients in a vaccine. You can imagine that because of limitations I do let the CDC, ACIP, AAP and vaccine experts help determine what is safe and use their guidelines thoughtfully.
I don’t claim to keep up on every comment, and often I let the crowd and public, like you, respond.
So your curiosity around responding is more a bandwidth issue than a choosing not to answer. Your first sentence was pithy enough you got my attention.