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Identifier

000438351

Title

Η στρατηγική Cocooning στον εμβολιασμό: παρελθόν, παρόν και μέλλον Cocooning in vaccination: past, present and future

Alternative Title

Cocooning in vaccination: past, present and future

Author

Αλιφιεράκη, Στυλιανή

Thesis advisor

Βεργαδή, Ελένη
Γαλανάκης, Εμμανουήλ
Σμυρνάκης, Εμμανουήλ

Abstract

Background: Despite medical advances and the development of effective and safe vaccines, infective agents threaten public health necessitating further preventative measures to be implemented. Cocooning is a well-known vaccination strategy, in which the close contacts of a vulnerable individual, who is not able to be vaccinated, get immunised. This practice indirectly creates a protective environment for the “at-risk” individual through reduced transmission of the respective vaccine-preventable disease (VPD). Objectives: Aim of the current study is to present a chronology of the cocooning vaccination strategy with main focus on the applications and uptake, limitations and benefits as well as the future implications of the strategy. Methods: The methodology used for the conduction of the study was literature review on the following international medical databases: MEDLINE, Embase, Journals Ovid, AMED, Global Health, Cochrane library and Scopus. The keywords used for the search were: [Cocooning AND Vaccin*] OR [Cocooning AND Immun*]. Articles only in English and those referred to the cocooning vaccination strategy were included. Studies in other languages and the ones using cocooning as a shielding strategy were excluded. Results: The pertussis resurgence since the 1980s and the significant burden of disease in young infants led to the development of the Global Pertussis Initiative in 2001, in order to combat the problem. Amongst the solutions suggested, cocooning was a well-promising strategy and official recommendations from CDC/ACIP followed in 2006. The strategy was subsequently used for the infantile protection against influenza. Increasing evidence around its implementation difficulties, the high cost and poor uptake and effectiveness gave rise to the revision of the guidelines. Simultaneously, other vaccination strategies for prevention of pertussis in infants were examined and maternal immunisation in pregnancy (MIP) dominated as a safe and effective strategy, through the additional transplacental transmission of antibodies and protection since birth. Since 2012, CDC/ACIP and ACOG recommend the Tdap vaccination from the end of 2nd trimester in every pregnancy. Cocooning remains a complementary strategy in the cases where MIP has not been achieved. Ongoing evaluation of the two strategies show a higher effectiveness and less cost of MIP but cocooning seems to be the most cost-saving strategy with higher benefit at a societal level. Through the years, the role of cocooning has expanded to the protection of other vulnerable groups (immunosuppressed, elderly) with further applications but less well-established recommendations. Conclusion: The role of cocooning at present is debatable due to its numerous logistical challenges, cost and ambiguous effectiveness, which compromise its implementation. On the other hand, the public health benefits it confers for the most vulnerable individuals, the educational and ethical perspectives of this strategy call for further attention. If certain facilitators are encouraged, the strategy can have a significant impact on the future vaccination strategies. The fact that new diseases continuously emerge, and new vaccines make their appearance means that cocooning will have an ongoing role in the protection of the non-negligible portion of the population who still cannot be vaccinated or mount adequate responses by themselves.

Language

Greek

Subject

Immunisation strategy

Immunosupressed individuals

Maternal immunisation

Vaccination strategy

Ανοσοκατεσταλμένοι

Εμβολιαστικά κίνητρα

Εμβολιαστική στρατηγική

Μητρικός εμβολιασμός

Issue date