In a whooping cough epidemic, is cocooning a useful strategy?

This paper has the structure of a critically appraised topic. It sought to assess the impact of Tdap vaccination in pregnancy or cocooning on pertussis among young infants during epidemics. The stages of evidence based medicine were followed: presentation of a clinical scenario; clinical question formulation; bibliographic research and critical appraisal of the selected studies. Finally, an answer for the clinical scenario is provided.

Two clinical guidelines were selected. No estimates were provided to evaluate the clinical importance of vaccinating pregnant women or cocooning in reducing morbidity and mortality of infants. However, it is known that the source of transmission of pertussis to infants occurs primarily at home and that vaccination of the mother after the 20th week of pregnancy increases levels of antibodies in infants without significant adverse effects.

Reviewers’ commentary: we conclude that in case of whooping cough epidemic, Tdap vaccination of pregnant women from 20 weeks of gestation can be considered due to the high rates of mortality and hospitalization among young infants. However, it is necessary that the public health authorities decide the policies to adopt. We think that any experience must be monitored to evaluate mid-and long-term results.