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Vaccinations
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Joshua H. Barash, Edward M. Buchanan
Pregnancy is an important part of the life cycle when certain infections can play a particularly destructive role. Pregnancy creates a relative immune suppression, which places a woman at greater risk of complications from illnesses such as influenza and varicella. Likewise, maternal infections with such viruses as varicella and rubella can cause a spectrum of fetal effects including congenital anomalies, fetal morbidities, and even fetal death. Finally, neonates are highly susceptible to complications from vaccine preventable diseases at a time when they do not receive full protection from vaccination themselves. Vaccination of an individual induces immunity, a process known as active immunization.Maternal vaccination also provides protection of the neonate through passive immunization, in which maternal antibodies (IgG) are transmitted transplacentally, particularly in the last 4–6 weeks of gestation [3]. An additional benefit may occur with the passage of antibodies (IgA) via breast milk. In addition, by immunizing close contacts of a newborn, the risk of exposure to disease is reduced, a strategy known as cocooning.
Preconception Care
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Annual influenza vaccination for patients and their partners contemplating pregnancy will reduce the chance of maternal prenatal infection, a time during which higher morbidity has been documented. Influenza vaccination for new mothers and other close contacts of the newborn will reduce the risk of infection for the child who is unable to receive vaccination until 6 months of age. Through this process of “cocooning,” the newborn is protected from the high morbidity and mortality rates associated with influenza in the first year of life [44].
Trends That Affect Quality of Life: Recreation as a Tool for Enhancement
Published in Miriam P. Lahey, Robin Kunstler, Arnold H. Grossman, Frances Daly, Stuart Waldman, Fred Schwartz, Recreation, Leisure and Chronic Illness: Therapeutic Rehabilitation as Intervention in Health Care, 2013
Americans will work harder and longer in the coming decade, with a prediction by some forecasting experts that we could be looking at 50–55 hour workweeks. “At home” leisure or “cocooning” is predicted to continue. Television viewing has stabilized, but, since 1980, there has been a 40 percent rise in in-ground swimming pools; home-delivery sales of food are growing twice as fast as takeout or “drive through“; pet ownership is at an all-time high; and there has been a 47 percent rise in retail sales of lawn and garden supplies since 1983.
Strategies to increase uptake of maternal pertussis vaccination
Published in Expert Review of Vaccines, 2021
Kavin M. Patel, Laia Vazquez Guillamet, Lauren Pischel, Mallory K. Ellingson, Azucena Bardají, Saad B. Omer
The decline in pertussis cases was not homogenous among populations from the 1980s to 2000s. Young infants, who cannot begin the primary diphtheria-tetanus-pertussis (DTP) vaccine series until 2 months of age, continued to remain at higher risk for infection and complications. In an effort to address this immunity gap, the Global Pertussis Initiative [8] and numerous high-incomes countries [9] started to recommend vaccination of postpartum women and other close contacts of infants (fathers, siblings, grandparents, etc.) in the mid-2000s as part of the ‘cocooning’ strategy [10,11] to create a wall of protection around susceptible young infants. For example, in 2008, the United States Advisory Committee on Immunization Practices (ACIP) was among the first to adopt cocooning with the tetanus-diphtheria-acellular pertussis vaccine (Tdap1). In 2010, the World Health Organization (WHO) acknowledged that while cocooning may be successfully implemented in certain high-income countries there was insufficient evidence to recommend the strategy universally given programmatic difficulties and unclear effectiveness [12,13].
Is there a potential for novel, nasal pertussis vaccines?
Published in Expert Review of Vaccines, 2021
In the absence of effective cocooning strategies, an alternative option could be neonatal vaccination. First attempts of at-birth DTP vaccination date back to the middle of the XXth century. However, while eliciting antibody responses to diphtheria and tetanus toxoïds, DTP vaccination was found to not elicit the desired serological responses to B. pertussis antigens, but instead induced a temporary immunoparalysis specifically to B. pertussis [66]. A small efficacy trial conducted in Nigeria over a two-year period showed no effect of neonatal DTP vaccination on the pertussis incidence [67]. Administration of an additional DTaP dose at birth also resulted in reduced antibody production to B. pertussis antigens after the primary course of vaccination when compared to children that had not received the neonatal DTaP dose [68]. On the other hand, a recent study with a stand-alone pertussis vaccine, without the tetanus and diphtheria valencies, given at birth resulted in significantly higher antibody levels after the 6-week DTaP administration, compared to controls who only received the 6-week DTaP [69]. The reasons for these conflicting findings are not clear but may be related to the addition of the diphtheria and tetanus toxoids in the DTaP vaccines that were not present in the stand-alone pertussis vaccine.
A systematic review of the burden of pertussis disease in infants and the effectiveness of maternal immunization against pertussis
Published in Expert Review of Vaccines, 2020
Walid Kandeil, Caroline van den Ende, Eveline M. Bunge, Victoria A. Jenkins, Maria Angeles Ceregido, Adrienne Guignard
‘Cocooning’ is a strategy that has been implemented to reduce the risk of pertussis transmission from mothers or family members to infants, by vaccinating women immediately postpartum, and all other close contacts with a combined diphtheria-tetanus-aP booster vaccine (Tdap). However, cocooning alone has proven to be insufficient to prevent pertussis morbidity and mortality in newborn infants [6]. In 2011, the United States (US) was the first country to recommend Tdap vaccination during pregnancy to protect infants in the first months of life through the passive transfer of maternal antibodies [7]. Several countries followed suite in 2012, including the United Kingdom (UK) in response to rising infant deaths during a pertussis epidemic in 2012 [8]. Vaccine effectiveness in preventing laboratory-confirmed pertussis in infants <3 months of age was more than 90% in the first 3 years of the UK program [9,10]. This was the first published evidence of the clinical benefit of a Tdap maternal immunization program [11]. Recommendations for maternal Tdap immunization now exist, with some differences in the recommended vaccination window, in over 40 countries (Table 1) [12–14]. Though evidence of the safety and benefits of maternal Tdap immunization is steadily increasing, many countries still do not have any recommendation concerning Tdap immunization in pregnancy. Where recommendations are in place, information on vaccine coverage is not always available or varies widely, ranging, for example, from 48.8% in the US in 2017 to 93.7% in the Bizkaia province of Spain [15,16].