"Cocooning" not effective in preventing pertussis infection in infants - Page 2

[Bokonon]

Originally Posted by erigeron 

May imply that, but that's a paraphrase chosen by a reporter of a statement issued summarizing the actual research, so I wouldn't read into it too much.

That's true.  I would like to see the actual study.

[Rrrrrachel]

There's a variety of reasons why the program wasn't effective. A vaccinated parent is still less likely to give their child pertussis. You cannot get a sub clinical case of pertussis from the pertussis vaccine, it is acellular.

[Bokonon]

Originally Posted by Rrrrrachel 

There's a variety of reasons why the program wasn't effective. A vaccinated parent is still less likely to give their child pertussis. You cannot get a sub clinical case of pertussis from the pertussis vaccine, it is acellular.

I wasn't implying that you can get a subclinical case of pertussis from the pertussis vaccine.  You can get a subclinical case by being exposed to pertussis and having been immunized against it.  Someone without symptoms is unlikely to take proper precautions with a newborn.  Having an obvious illness (actual pertussis symptoms) would cause someone to be more cautious around a newborn.

[Taximom5]

Originally Posted by Rrrrrachel 

. A vaccinated parent is still less likely to give their child pertussis. 

Please show a peer-reviewed study that concludes this, and that tells us how exactly much less likely a vaccinated parent is to give their child pertussis.

[BeckyBird]

Originally Posted by Taximom5 

Please show a peer-reviewed study that concludes this, and that tells us how exactly much less likely a vaccinated parent is to give their child pertussis.

Can't. There are only "educated" guesses. But they are guesses made by educated scientists, so is that good enough for you?

[nukuspot]

I'd say this is true after lots of research on my part (and I don't vax so I am not saying this from a pro-vaccine standpoint.)  The reason is because the pertussis vaccine is an antitoxin.  Even though a vaccinated adult can still get pertussis the antitoxin neutralizes the toxin the bacteria is making when it is dying---and that is what causes the cough.  So, a parent who has even a reduced cough is less likely to spread the bacteria to their baby by droplet form---which is how it is spread by coughing.

[nukuspot]

Our state (WA) is now doing a free Tdap clinic for all adults in contact with infants.  And honestly, even though I don't vaccinate my child, I think that is a good thing.  I still think cocooning makes logical sense.  It frustrates me that the article does not say WHY the researchers came to the conclusion it is ineffective.  I plan to implement cocooning when I have my new baby in a few months because it seems a better option than the alternatives 1,)  Vaccinate an infant and 2.)  Do nothing.

[Rrrrrachel]

Vaccination children for pertussis has been shown to decrease the incidence of pertussis and hospitalization from pertussis in vaccinated AND non-vaccinated populations. Someone who is vaccinated is less likely to get pertussis and if they do get it they are much more likely to have a milk case with less coughing. as was already pointed out the coughing is what makes pertussis so contagious. Less likely to get it in the first place and less coughing if you do get it = less likely to spread it and fewer cases and hospitalizations.

[erigeron]

Originally Posted by nukuspot  I still think cocooning makes logical sense. 

It does. But there are theories that make logical sense that don't end up actually panning out when they are tested scientifically, and there are theories that seem bizarre at first blush and then turn out to be true. This is pretty common.

It frustrates me that the article does not say WHY the researchers came to the conclusion it is ineffective.

Didn't it? They found there was no clinical advantage to cocooning=it was ineffective. I assume this means that either kids in the cocooning group got sick as often as those in a group that didn't practice it, or that the difference was so small as to be not worth pursuing when stacked up against the number of adults who would need to be vaccinated. (i.e. if you need to vaccinate 10,000 adults to prevent 1 case of pertussis, it may or may not be worth it.) If you mean why a theory that makes logical sense turned out not to pan out, they may not know themselves, but it sounds like even if they don't know *why* it doesn't help, they see *that* it doesn't help.

I plan to implement cocooning when I have my new baby in a few months because it seems a better option than the alternatives 1,)  Vaccinate an infant and 2.)  Do nothing.

If you're unwilling to vaccinate, cocooning vs not cocooning probably can't hurt, but I think we see here that we shouldn't necessarily expect it to help. On a population level, it didn't help. On an individual level, if your kid doesn't get pertussis, was it because of cocooning or not? Nobody knows; the singular of data isn't anecdote.

[Rrrrrachel]

Just to be clear, this was not a study. They didn't have a cocooned group and non cocooned group and then compare them. This was just a government program that was found not to work. It may not have worked because they couldn't get a sufficient umber of people who come into contact with the baby to get vaccinated. This is a known problem with cocooning. That doesn't mean it won't help nuku's baby.

[Bokonon]

Originally Posted by Rrrrrachel 

Just to be clear, this was not a study. They didn't have a cocooned group and non cocooned group and then compare them. This was just a government program that was found not to work. It may not have worked because they couldn't get a sufficient umber of people who come into contact with the baby to get vaccinated. This is a known problem with cocooning. That doesn't mean it won't help nuku's baby.

Again, that's not what the article stated.  The article stated that the strategy was clinically ineffective.

[Rrrrrachel]

Which only means they didn't have a drop in pertussis cases. It doesn't provide any info about why. These were not controlled conditions.

[Bokonon]

Originally Posted by Rrrrrachel 

Which only means they didn't have a drop in pertussis cases. It doesn't provide any info about why. These were not controlled conditions.

How do you know that?  The committee was given information from 2 pharmaceutical manufacturers; I assume (and yes, I know that is dangerous) that the information was based on studies.  They may or may not have been controlled conditions - we have no way of knowing based on the article.

[Rrrrrachel]

Good point. We are both making assumptions. I still don't think it means we should throw the whole idea of cocooning overboard, though, especially when there are studies that show it DOES make a difference.

[Taximom5]

Originally Posted by Rrrrrachel 

Good point. We are both making assumptions. I still don't think it means we should throw the whole idea of cocooning overboard, though, especially when there are studies that show it DOES make a difference.

But aren't those studies tainted because they were tied to the industry who produced the vaccines?

[Turquesa]

Originally Posted by Rrrrrachel 

Good point. We are both making assumptions. I still don't think it means we should throw the whole idea of cocooning overboard, though, especially when there are studies that show it DOES make a difference.

First, it would be really helpful if you would get in the habit of providing citations/links in your posts, especially when making statements like "studies show..."

Second, I would say that in matters of public policy, the burden of proof rightly rests on the shoulders of the party making the claim and demanding the change. So before requesting taxpayer money and public compliance with a wide-scale medical intervention, the parties wanting to see "cocooning" take place should be providing ample proof that it is a safe, effective, and cost-effective strategy. Because they clearly failed in that regard, Australian officials did the right thing and stopped funding TDaP for cocooning purposes. If anybody protests this measure, it's more than fair to revisit the issue when they can pony up on better science and data.

[Rrrrrachel]

I'm not contesting the decision in Australia at all. Im just pointing out its hardyl conclusive.

I'm not in the habit of speaking in apa format, and I don't intend to start, sorry. Especially when it's a total double standard. I will try to provide a source when asked, but otherwise you'll just have to take it fwiw, kind of like most things on the Internet.

[nukuspot]

I still don't see anything in that article that tells me anything more than "It didn't work so we discontinued the policy".  I wish there was a link to the actual findings of the investigative committee.  Even if a random committee in Australia found for some unspecified reason cocooning didn't work on a public health scale, it still makes sense to this mama. 

Now seriously, I am not arguing that cocooning makes sense on a pro-vax standpoint here.  Let me be clear.  I don't vaccinate my daughter at this point in her life.  I have thought about it (especially recently) and still don't see a favorable risk/benefit ratio.  But I am not against vaccination full stop.  I just question the safety, especially in children.  That said, when I weigh the pros and cons of cocooning vs not cocooning it still seems like the sensible option for me and also for others.  I don't worry much about my DH getting a vaccine reaction since he is full grown with no history of health issues.  (As a matter of fact I just got him to get Tdap since we will be doing cocooning--I am immune myself from actually having pertussis 4 years ago, I got my titer checked.)  I also don't see any reason for the rest of our adult immediate family (grandparents) to get the Tdap before coming to visit the newborn.  If the alternative is to do nothing, why not be proactive (for consenting adults who are willing and happy to get Tdap to get it)?  And I am speaking for my own family here, but I do see it as a microcosim of a whole.  I don't see why cocooning should be discouraged on this forum and elsewhere?

Even if my version of cocooning is not totally without holes (since my toddler is un-vaxxed) it seems sensible to try as hard as I can to prevent adults from getting pertussis and bringing it into the home.  The CDC MMWR from 2008 says that computer models showed a newborn has a 38% less chance of catching pertussis if both parents are vaxxed.  And the numbers go up to 75% if all family members coming in contact with the new baby are vaxxed with Tdap.

Where it gets murky is that I don't necessarily agree with kids getting vax pushed on them by the state.  So the part of cocooning that our state (WA) is currently implementing with doing boosters in middle and high schools kind of freaks me out.  I mean, parents do have a right to decline the vax for their kids in this state, but it seems too much like forced vaccination in that case.  However, I am all for a consenting adult (or older child) willingly walking into a pharmacy or Dr. office and requesting a booster because of cocooning...

[Turquesa]

Originally Posted by Rrrrrachel 

I'm not contesting the decision in Australia at all. Im just pointing out its hardyl conclusive.
I'm not in the habit of speaking in apa format, and I don't intend to start, sorry. Especially when it's a total double standard. I will try to provide a source when asked, but otherwise you'll just have to take it fwiw, kind of like most things on the Internet.

Cutting a link and pasting it into an MDC post is hardly as painstaking as figuring out the APA format.  And no, on a conversation as pivotal as vaccinations, I will not take a "FWIW" approach to unsupported statements.  Most doctors already expect me to do that, thank you very much.     Anyway, go ahead and leave out the supporting evidence, if you so choose, but don't expect your statements to be taken seriously without it.  In these discussions, I expect facts and data.  But that's just me.  I'm a woman of high standards.    

[Rrrrrachel]

That's what fwiw means, ignore me if you'd like. Its a complete double standard, though. I don't see you asking anyone else for citations for comparable statements.