"Cocooning" not effective in preventing pertussis infection in infants - Mothering Forums
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#1 of 50 Old 05-08-2012, 12:52 PM - Thread Starter
 
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http://www.news.com.au/breaking-news/states-ending-free-parent-whooping-vaccine/story-e6frfku0-1226350174856

 

 

"...the national Pharmaceutical Benefits Advisory Committee (PBAC) had determined vaccinating parents was not effective in protecting newborns, after two pharmaceutical manufacturers made submissions to the PBAC.

"The PBAC, which is totally independent and very expert, has determined that there is no clinical effectiveness of this strategy," Professor Brook said.
He said this had made it clear the cocooning strategy should not be continued."

 

I'd like to see more info about this, but it is an interesting development.

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#2 of 50 Old 05-08-2012, 04:02 PM
 
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I was going to post this, but you beat me to it!

 

Interesting that the US press has not reported this. Then again, they didn't report that Dr. Walker-Smith won his appeal, either.

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#3 of 50 Old 05-08-2012, 04:48 PM - Thread Starter
 
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I wish the U.S. had a "totally independent and very expert" pharmaceuticals committee!


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#4 of 50 Old 05-08-2012, 05:09 PM
 
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There's always been a lot o dispute over whether this is an effective (and cost effective) way to fight pertussis.

http://m.theatlantic.com/health/archive/2011/12/cocooning-doctors-divided-on-vaccine-strategy-to-protect-babies/250521/
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#5 of 50 Old 05-08-2012, 06:40 PM
 
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Isn't cocooning just another form of herd immunity? So, if cocooning for pertussis doesn't work, then what does that tell you about herd immunity.....

 

"Lessin acknowledged that there isn't much evidence on how effective cocooning really is. "It's a relatively new concept," he said. "I don't know that anyone has looked at whether it works." The Canadian study, published in the journal Clinical Infectious Diseases, takes a stab at that, although it's based on calculations instead of an actual experiment."
 
Remember the guilt directed at the parents who didn't vaccinate to protect their babies?
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#6 of 50 Old 05-08-2012, 06:46 PM
 
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Cocooning isn't really the same as herd immunity, no. There are a variety of reasons why cocooning may not be effective, including insufficient compliance rates, particularly among not-mothers. On a small scale cocooning has been shown to work, but that doesn't mean it's effective or efficient on a large scale.

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#7 of 50 Old 05-08-2012, 07:23 PM
 
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But the whole concept of coccooning is a big FAIL with pertussis if the vaccine does not prevent transmission of the virus.

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#8 of 50 Old 05-08-2012, 07:29 PM
 
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It lowers the risk of transmission, it doesn't prevent it entirely.

It's not entirely clear from this article what information they're using to come to this conclusion. My reading is that this is a failed public policy so they are ending it. Fair enough. It's not clear, though, why it failed. It could have failed because they were unable to sustain sufficient vaccination levels to get results.
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#9 of 50 Old 05-08-2012, 07:53 PM
 
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This is from the article,

 

"[Department of Health divisional executive director Chris Brook] said the national Pharmaceutical Benefits Advisory Committee (PBAC) had determined vaccinating parents was not effective in protecting newborns, after two pharmaceutical manufacturers made submissions to the PBAC."

 
From my understanding, cocooning was a theory that sounded great, but didn't actually work. It's noble of them to admit this. One step forward for the medical community--if something doesn't work, find out what will!  Isn't that what we want?
 

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#10 of 50 Old 05-09-2012, 03:32 AM
 
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I agree, I'm glad they stopped a policy that wasn't working.
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How long til the US does the same thing?  i doubt they will...

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The us doesn't have a comparable program to stop.
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#13 of 50 Old 05-09-2012, 07:17 AM - Thread Starter
 
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Originally Posted by Rrrrrachel View Post

The us doesn't have a comparable program to stop.

 

But doctors and pharmacies still push the Tdap and guilt new parents into getting it.  It may not be a program, but it's false information, and probably puts infants MORE at risk, because the recipients of the Tdap think they are safe from transmitting pertussis.


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#14 of 50 Old 05-09-2012, 07:41 AM
 
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I dont know about the more at risk, they are still less likely to spread pertussis to the infant because thy are vaccinated.

This was a nationwide initiative that involved free vaccines. We don't do free vaccines here and I dot think the aap even officially recommends cocooning, they just don recommend against it, either. Theres no program to stop.
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#15 of 50 Old 05-09-2012, 08:58 AM
 
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vaccinations can increase the risk of exposure to the newborn in certain cases.  


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#16 of 50 Old 05-09-2012, 09:11 AM
 
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I don't think that's true that all vaccines cause shedding. Certainly with an attenuated vaccine like pertussis even if you are shedding you are shedding a weakened form that really can't make anyone sick.
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#17 of 50 Old 05-09-2012, 09:11 AM
 
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Whoa, now I look crazy.
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#18 of 50 Old 05-09-2012, 03:28 PM
 
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I dont know about the more at risk, they are still less likely to spread pertussis to the infant because thy are vaccinated.
This was a nationwide initiative that involved free vaccines. We don't do free vaccines here and I dot think the aap even officially recommends cocooning, they just don recommend against it, either. Theres no program to stop.

Actually, for those with insurance, pertussis vaccines ARE free, as the cost is covered by the insurance.

There has been a big push for older children and adults to get a "pertussis booster," which is almost always a TDaP, eveif they are up-to-date on tetanus boosters (which are almost always TDaP).
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#19 of 50 Old 05-09-2012, 05:18 PM - Thread Starter
 
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I dont know about the more at risk, they are still less likely to spread pertussis to the infant because thy are vaccinated.
 

 

The article said that it was determined that "vaccinating parents was not effective in protecting newborns", which implies that they were NOT less likely to spread it.  And with a subclinical infection due to the vaccine, spreading illness might be more likely."No clinical effectiveness".  

 

Not a word about it being financially ineffective.

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#20 of 50 Old 05-09-2012, 05:38 PM
 
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The article said that it was determined that "vaccinating parents was not effective in protecting newborns", which implies that they were NOT less likely to spread it.

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.

 

Shedding is only a risk with live vaccines. The pertussis vaccine provokes your immune system to respond to a toxin produced by the bacteria that causes pertussis. No live parts to worry about.

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#21 of 50 Old 05-09-2012, 05:39 PM - Thread Starter
 
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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.

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#22 of 50 Old 05-09-2012, 05:43 PM
 
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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.
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#23 of 50 Old 05-09-2012, 05:46 PM - Thread Starter
 
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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.


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#24 of 50 Old 05-09-2012, 06:52 PM
 
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. 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.

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#25 of 50 Old 05-09-2012, 07:40 PM
 
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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?


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#26 of 50 Old 05-09-2012, 07:47 PM
 
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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.


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#27 of 50 Old 05-09-2012, 07:50 PM
 
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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.


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#28 of 50 Old 05-10-2012, 05:37 AM
 
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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.
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#29 of 50 Old 05-10-2012, 09:15 AM
 
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Originally Posted by nukuspot View Post 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.
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#30 of 50 Old 05-10-2012, 09:40 AM
 
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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.
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