Nation's First "Cocoon Strategy" Vaccination Program Delivers 10,000th Immunization

HOUSTON -(Feb. 1, 2010) - Physicians from the Center for Vaccine Awareness and Research at Texas Children's Hospital reported that 10,000 Tdap immunizations have now been administered to the mothers and immediate family members of newborn babies at Harris County Hospital District's Ben Taub GeneralHospital, where the patient population is generally at higher risk for pertussis infection.

The immunizations are part of one of the nation's only major "cocoon strategy"vaccination programs, designed to protect newborn infants from the life-threatening and highly contagious pertussis infection, more commonly known as whooping cough.

Nearly 75% of infants who contract whooping cough are infected by someone in their household and nearly two-thirds of infected infants under 6 months are hospitalized.Immunity from the vaccine wanes after 5 to 10 years. In 2008, whooping coughcases in the U.S. rose 27% over the prior year to 13,200 cases, with 15%(2,048) in Texas. Nationally there were 20 deaths, 4 of which occurred inTexas, including one in Houston. All reported deaths were infants under 6months of age.

The cocoon strategy is recommended by the Centers for Disease Control and Prevention (CDC)as the only protection against whooping cough available to infants less than 6months of age, too young to be protected by their childhood vaccines given at2, 4 and 6 months of age. The "cocoon" is created by vaccinating family members who will be in close contact with the infant so that the baby is surrounded by people who cannot spread the infection. The Texas Children's program was implemented in 2008.

"The program's acceptance by families has exceeded our expectations," said Dr. C.Mary Healy, program leader and director of Vaccinology and MaternalImmunization at the Center for Vaccine Awareness and Research at TexasChildren's Hospital.

She reports that 96% of women who delivered babies at Ben Taub General Hospital and did not report a contraindication to the vaccine were immunized. An average of 2 family members per newborn have received the vaccine through the program and as many as 10 in a single family have participated. As recommended by the CDC, 91% of the immunized family members were vaccinated prior to the infant being discharged from the hospital.

Of those who received Tdap through the program to date, 93% were of Hispanic ethnicity and11% were less than 20 years of age, both factors that place mothers at a statistically higher risk of acquiring whooping cough and passing the infection to their young infant.

The program team, which is a collaboration of doctors from the Texas Children's Center for Vaccine Awareness and Research as well as the Departments of Obstetrics and Gynecology, Pediatrics, Neonatology, Nursing and Pharmacy at Ben Taub General Hospital, communicates with families in both English and Spanish to educate the mother and her family about the benefits of the cocoon strategy.

"This innovative project is part of a joint wellness and prevention program," said Dr. Kenneth L. Mattox, chief of staff, Ben Taub General Hospital. "It demonstrates a very beneficial cooperative program among several health care delivery venues to protect our youngest patients."

In order to achieve such high acceptance rates for the vaccine, Healy said that educating hospital care givers and patient families is a key factor. In-service training about pertussis for Ben Taub's staff raised awareness and advocacy for the program. This training helps hospital care givers in explaining the program and its benefits to postpartum mothers. Bilingual educational pamphlets are distributed to families and Texas Children's cocoon strategy team members are available in person 5 days a week or by phone 24-hours a day to answer any questions or concerns that arise.

While the public health benefits of the cocoon strategy are apparent, Healy noted that the program has not been widely implemented by other heath care organizations because of the planning and infrastructure needed.

"The cooperation and support of Ben Taub General Hospital has been instrumental in making this program such a success," said Healy. "Through our joint efforts, we have already protected thousands of infants from a potentially deadly disease and helped to stop the spread of pertussis in our community."

The cocoon strategy vaccination program administered by Texas Children's Hospital is made possible by financial grants from the Baylor Methodist Community Health Fund and Children's Health Fund of the Harris County Hospital District Foundation, as well as donated physician time and thousands of doses of donated Tdap vaccine.

Since the implementation of the cocoon strategy here in Houston, Healy has been contacted by doctors, hospital administrators and other medical professionals from around the country seeking information on how to develop such a program. Most recently, she has consulted with physicians and public health officials fromWilliamson County, Texas, because the area is in the midst of a major pertussis out break. Healy has been asked to present information on the cocoon strategy vaccine program to physicians statewide during an upcoming Texas Department ofHealth webinar. She will also make a presentation to the CDC later this year.

"It is important to share with other healthcare professionals what we have learned from the implementation and ongoing operation of the cocoon strategy," said Dr.Carol Baker, executive director of the Center for Vaccine Awareness andResearch at Texas Children's Hospital. "Programs like this are at the heart of our mission to research more effective vaccine delivery models."

About Texas Children’s Hospital

Texas Children’s Hospital, a not-for-profit health care organization, is committed to creating a healthier future for children and women throughout the global community by leading in patient care, education and research. Consistently ranked as the best children’s hospital in Texas, and among the top in the nation, Texas Children’s has garnered widespread recognition for its expertise and breakthroughs in pediatric and women’s health. The hospital includes the Jan and Dan Duncan Neurological Research Institute; the Feigin Center for pediatric research; Texas Children’s Pavilion for Women, a comprehensive obstetrics/gynecology facility focusing on high-risk births; Texas Children’s Hospital West Campus, a community hospital in suburban West Houston; and Texas Children’s Hospital The Woodlands, a second community hospital planned to open in 2017. The organization also created the nation’s first HMO for children, has the largest pediatric primary care network in the country and a global health program that’s channeling care to children and women all over the world. Texas Children’s Hospital is affiliated with Baylor College of Medicine. For more information, go to www.texaschildrens.org.