AND NOW: A GRANDMA AND ZAYDE SHOT TO PROTECT THE BABY

For many years, the vaccine combination of DPT, diphtheria, pertussis (whooping cough), and tetanus was given as part of the regular schedule only until the age of about five.  Booster doses for adolescents and adults consisted of only the tetanus and diphtheria components, based on the expectation that the antibody protection against pertussis would be long lasting.  In 2005, after a number of pertussis outbreaks in adolescents and the recognition of many cases in adults, this protocol was changed, and starting at about age 11 a revised product referred to as Tdap (brand names Boostrix and Adacel) reintroduced the pertussis component.  Adolescents were given this enhanced product, which provided important  long-lasting boosting  of whooping cough protection.  Over time this vaccine has increasingly been given to adults to provide the same protection, as studies have shown that a substantial percentage of illnesses with cough of several weeks’ duration is actually due to unrecognized adult pertussis.

However, there is an important bonus to having young adults protected against pertussis when they become the parents of a newborn infants.  Although (hopefully) these babies will receive their own whooping cough immunity as they get their own vaccines, there is a period of vulnerability.  Until first immunization at  six to eight weeks  (and even a few additional weeks until antibodies are produced) they are fully susceptible to pertussis should they be exposed.  And really dependable  protection is assured only after the second dose a couple of months later.  Since many studies have demonstrated that most cases of infant pertussis are acquired from unrecognized infection of family members caring for babies, it is highly adviseable that parents and other close relatives assisting in this care be vaccinated with Tdap anytime before or just after the birth of the new family member.

And how do grandparents figure into all this?  Not surprisingly, pretty prominently.  In one study of over a thousand children under three years of age, 35% of them were cared for by grandparents for at least three months.   Even without specific studies, it is obvious that grandparents or other older family members  very frequently assist in the care of  newborns and young infants, usually with very close contact.  And here is where Tdap immunization has been a bit more problematic:  to date, both brands are  licensed for use only up to 64 years.  However,  there is now enough published evidence that these vaccines are considered safe and effective in individuals 65 years and older, and in a policy statement in the October 2011 issue of Pediatrics , the A.A.P. is now recommending vaccination for all older individuals in the setting of care for young infants–grandparents, other family, and all health care personnel.

The term that has been adopted for providing this pertussis-safe haven for young infants is “cocooning,” and with this newest recommendation the cocoon should be an even more secure one.  But the last word is that all infants should still receive their own vaccines according to the recommended schedule.  Whooping cough remains a potentially devastating infection and is highly preventable.