Cocooning: A vaccine strategy to protect infants

Son after immunizations (4 months old)

I just learned a new way to use a familiar word. Cocooning is the strategy where close family members of infants are vaccinated to protect infants who are too young to get shots themselves. Babies have to be at least six weeks old to get vaccines like TDaP and six months old to get the flu shot.

My husband and I tried to institute a smaller version of cocooning when our son was born. We asked that all family members make sure that they were current on their vaccines, with particular note paid to more rare immunizations, like the one for pertussis (whooping cough). Our request was only partially successful.

Cocooning is backed by the CDC, as evidenced in many of their vaccine recommendations that adults who have close contact with infants should also get a dose of _____ (recommended vaccine). However, not much research has been done on the practice.

One barrier to the use of cocooning is the hefty price tag. Canadian government researchers estimated that preventing one infant death would require vaccination of at least one million parents. American Academy of Pediatrics (AAP) reports on cocooning, released in the journal Pediatrics, do not directly recommend that pediatricians start offering shots to parents. "What it says is, if you choose to do it, this is OK," said the AAP's Dr. Herschel R. Lessin, who worked on the report.

"The goal here is to get everyone immunized," said Lessin. "As pediatricians, we think immunization is the greatest thing in the history of mankind."

Lessin acknowledged that there isn't much evidence on how effective cocooning really is. "It's a relatively new concept," he said. "I don't know that anyone has looked at whether it works." The Canadian study, published in the journal Clinical Infectious Diseases, takes a stab at that, although it's based on calculations instead of an actual experiment.
From past research, Skowronski and her colleagues estimated that whooping cough in infants could be blamed on parents passing the disease along some 35 percent of the time. (from "Cocooning: Doctors Divided on Vaccine Strategy to Protect Babies")

I think it's a simple enough thing to add myself and my family to the ranks of the well-vaccinated. Each person vaccinated creates a small but important measure of protection for themselves and those around them.

Debunking flu myths: Why you should get your vaccination now

I hope that you'll allow me to step back onto my vaccination soapbox for a moment.

I just read a news story that chilled this mother's heart. Four-and-a-half-year-old Amanda Kanowitz was healthy until she began to show her first symptoms—cough, low fever, and vomiting. Her doctor suspected a common childhood bug and recommended fluids and rest. Three days later, her parents found her lifeless in her bed.

Amanda had the flu. Seven years ago, when she died, doctors did not recommend shots for kids her age. That has changed. Now the CDC recommends flu shots for everyone over 6 months old.

I hate to be the one to pass along such a sad story, but I am doing so in the hope that it will help save lives. Only 43% of Americans got a flu shot last year, and that was a record year. The article that I read, on how to "Separate the facts from flu fiction," ran through several common flu myths. I'll highlight two, but I urge you to read the article for more information.

Myth 2: The flu shot causes the flu.

About 35% of consumers think the flu vaccine can cause flu, CVS found. But that's impossible, CDC says, because the viruses in the flu shot are dead. Its most common side effect is a sore arm. Mist nasal spray contains weakened viruses, so they don't cause severe symptoms, either. Side effects in kids can include a runny nose, wheezing and headache.

Myth 4: Only sickly people need a flu shot.

Half of consumers think flu shots are only for kids or sick people, CVS found. Actually, the most vulnerable members of society, such as newborns or those with weak immune systems, often can't get flu shots. The only way to protect them is to vaccinate everyone around them, keeping flu viruses out of circulation, Bergen says. Because babies can't be vaccinated until they're 6 months old, they depend on vaccinated friends and family members to create a "cocoon" of protection, Bergen says.

I'm sure that you have already read my past blogs on the flu and vaccines (right?), but on the off chance that you haven't, here's a link to my posts on vaccination. If you still need to get your flu shot, please go to your nearest pharmacy (many of them are located in your local grocery store) and take a few minutes to protect yourself and your loved ones. If you have already received your flu shot, here's a big THANK YOU from me and my family.

The beginning of the end for the flu virus?

Vaccines have been the weapon of choice against viruses, and I have talked about them here on several occasions. Now research is exploring a new therapy: an antiviral drug called Double-Stranded RNA Activated Caspase Oligerizer (DRACO). Catchy name aside, what does DRACO do? It targets cells that have been infected by a virus, hunting the signature mechanism by which viruses reproduce.

The majority of viruses reproduce in four steps:

1. Fixation and entry of the virus into the targeted cell.
2. Copy the genes of the virus using the cell’s power.
3. Bundling of virus particles.
4. Emergence of many copies of the new virus to spread the infection to other cells.

Dr. Todd Rider and his colleagues from the Massachusetts Institute of Technology, are targeting the second step in the viral reproductive process. When their genetic material is copied inside the cells, the virus produces a structure called “double-stranded RNA”; because this unique structure is missing in non-infected cells, a protein tied specifically to the double-stranded RNA allows for the specific targeting of the cells containing the virus. By combining this protein with another protein that triggers cell death through apoptosis, it becomes possible to eliminate the infected cells without any side effects on the healthy cells.

Still with me? In short, DRACO targets cells with long strings of double-stranded RNA, causing them to commit cell suicide while ignoring the other healthy cells.

Dr. Rider's research has been tested on 15 different viruses, including H1N1 influenza, and it was effective against them all. The possible catch is that this research was primarily conducted on mammalian cells cultured in a lab, which leaves the possibility that the drug might not work on living animals. More recent work on the drug's effect on mice infected with influenza has continued to yield promising results.

If perfected, DRACO could revolutionize the treatment of viral diseases. Vaccines are effective, until the virus mutates. An antiviral drug could continue to work when vaccines fail. More research and time is needed to determine whether the new treatment is safe and effective for treating viral infection in humans.

Get your flu vaccination now

It's time to schedule your flu vaccination.

Most of us think of flu clinics as we head into October and the weather cools, if we think of them at all. It's still in the triple digits here, but I already have my flu vaccination scheduled (September 27). Unlike the 2009 H1N1 pandemic, this year flu vaccine stocks are plentiful and health departments are urging early vaccination.

The CDC recommends that everyone six months and older should get the flu vaccine each year. I most definately agree. At the forefront of my memories are the last time that I was sick with the flu (in college I was so weak after that I couldn't walk to my class across campus) and my personal experience of what happens when vaccine is not available. My son will be getting his vaccination at the end of the month, during his Well Child visit.

Please help contain this preventable disease by making vaccination a priority. A simple shot or nasal spray can protect your family, friends, and acquaintances, particularly the little ones who can't make this important health decision for themselves.

Good news for toddlers getting their flu vaccine

Nasal spray vaccine
Nati Harnik/Associated Press

Good news for children under three years! Toddlers receive the same protective antibody response from the recommended two doses of licensed seasonal flu vaccines administered through any of these methods:

• Injected by needle
• Inhaled through nasal spray
• Provided through one dose of each, in any order

The goal of the study, funded by the National Institutes of Health (NIH), was to determine whether giving two types of vaccines works just as well.

Even better, the researchers found that the toddlers who received at least one dose of the nasal spray vaccine—a live, attenuated influenza virus vaccine (LAIV)—made a wide array of immune T cells. Stimulating broad T-cell responses may be important for protection against many diverse flu strains.

This is good news for parents as well. My son seems to bring home every bug that goes through his daycare, so it's good to know that we can help prevent at least one. Getting your little one vaccinated also protects their playmates, teachers, parents, and other caregivers. Please make sure that you talk to your doctor about immunizations. If in doubt, feel free to read some of my blogs on vaccines, particularly the one titled "Vaccines are a victim of their own success."

Flu Vaccine Pill Designed by Teen

Formulation V720 is the world's first and only flu vaccine in pill form. The vaccine is the same as what would be used in vaccinations, but the delivery method is a hard-shelled, multi-component capsule designed to move through the digestive system and release only when it reaches the small intestine. From there, the vaccine can be absorbed into the lymphatic system, which then generates an immune response.

Grant Sparling

The vaccine pill was developed by Medicine for a Better Tomorrow, a 10-member team attending an enrichment program at a university. Eighteen-year-old Grant Sparling is the president of the team. They decided to develop the new vaccine delivery system in response to the challenge to develop a product for the aging population of Canada. People age 65 and older are more susceptible to influenza, but as age increases, so does the fear of needles.

Patents and research are still pending, but almost a dozen doctors have confirmed that the science behind the idea is sound enough for research to be done.

For more details, you can follow these links:

• MBT CEO Named One of "Canada's Top 20 Under 20" for 2011
• Blythe teen designs new vaccine
• Grant Sparling's School Profile (PDF)

Young people have a wonderful way of looking at common problems in a new way. The fact that they have fewer preconceptions about how something should be done, means that they can come up with deceptively simple but innovative solutions. I will be keeping an eye out for more news regarding a flu vaccine pill. Medical research is not a fast process—it is painstaking and thorough—but if the idea can be developed and approved for production, a vaccine pill would revolutionize immunization programs.

Vaccines are a victim of their own success

Preventable childhood diseases are on the rise. So far this year, twice the usual number of measles cases have been diagnosed. It is the biggest outbreak seen in 15 years. A CDC staff member compared measles to a canary in a coal mine; it is the first sign of issues with vaccine coverage.

My son just recovered from the Coxsackievirus, so I can tell you how hard it is to see your child suffer. As his mom, I fought just to get him to drink while I watchfully checked him for signs of complications, such as meningitis. He could not understand why he felt bad and why it hurt when he tried to eat or drink. All I could do was try to offer comfort. I would gladly have been sick in his place. This only reinforced the decision to vaccinate on schedule, which I had already based on my knowledge of medical science and public health.

So why do parents refuse or delay vaccines? Here is a short list of possibilities, which is discussed in more detail in the following article:

• Vaccines are a victim of their own success. When you have never seen the horror of a disease, it is easy to forget that it exists.
• Parents do not realize that they are gambling the lives of not only their own kids, but also the lives of all the children around them.
• Fear caused by myths about vaccines and autism. Today's media-driven society makes it very easy to scare people.
• Influential sources claiming that diseases are a minor threat.
• States granting exceptions to vaccinations for philosophical reasons.

Childhood diseases return as parents refuse vaccines

Landon Lewis, 4, was living in a Minneapolis homeless shelter when he fell ill, first with a fever of 104 degrees, then with a red rash on his forehead.

It took two visits to a doctor to diagnose a disease clinic staff hadn't seen in years: measles.

The rash spread into his mouth and throat, so swallowing was torture. He began vomiting and developed a cough that nearly choked him. He was rushed to the emergency room and hospitalized for five days.

Click here to read more of this USA Today article.

Lozenges to Cure the Flu

Here's a novel approach to curing flu outbreaks: a preventative lozenge. If you think you have been exposed, you pop a lozenge in your mouth and ready-made antibodies give you protection. The lozenge works by using the immune system of the stomach and intestines. The challenge with this approach is that the benefits are short-term. You are only protected for one day. A single flu shot for the year seems much more practical, particularly considering the fact that influenza is the only virus that requires a new vaccine every year; it is constantly changing.

There do seem to be benefits to the flu lozenge as an alternative therapy. If you haven't been able to get your flu shot yet, you can suck on a lozenge each day until you make it to your doctor or clinic for the vaccine. Researchers hope their lozenge can be sold over the counter, which would make it readily available.

For more details about the flu lozenge research, you can refer to the article Suckers for flu research go ferreting for a cure. Perhaps the journalist had a bit too much fun with puns.

Influenza Science Behind Dormant

I love research, and I did a lot of it before and during the writing of my current Work in Progress. This is the first blog in a series touching on the science behind Dormant. I will post one a week until I run out of topics. Even a science fiction novel needs a foundation in real science, at least in the view of this geeky writer. 





Flu Virus Sculpture by Luke Jerram

In Dormant, journalist Jackie Davenport must stop a pandemic caused by the awakening of a dormant and lethal strain of flu. 



My research into the flu started with an interest in the 1918 Influenza Pandemic. Flu is spread through coughs and sneezes. This is why health departments distributed Cover Your Cough posters during the H1N1 Influenza pandemic.

My novel is set during the winter for a reason. Influenza tends to be more infectious in cold temperatures. The virus can lie dormant in its host during the warmer months, waiting to grow stronger and become a full-fledged infection during the cold winter months. While dormant, the virus migrates globally and mixes with other viral strains before returning as a genetically different virus. This difference helps it evade the immune system.

Why is temperature such an important indicator of flu virulence? Scientists at the National Institutes of Health (NIH) may have answered this question. According to an article in Nature Chemical Biology, cold winter temperatures cause the virus’ outer envelope (covering) to harden to a rubbery gel. This could shield the virus during its transmission. Warmer summer temperatures cause the protective gel to melt to a liquid phase. Because this liquid phase is not enough to protect the virus against the elements, it loses its ability to spread from person to person.

Vaccinations play a vital part in stopping viral outbreaks. But what if there is not enough vaccine? I already mentioned the vaccine shortfall during the H1N1 Influenza pandemic. That this lack did not become a bigger problem is a tribute to the efforts of public health professionals who worked around the clock to distribute the limited supply to priority groups with an intentional plan that gradually widened the availability as supply caught up with demand.

All of this creates interesting possibilities for modes of transmission and ways to thwart a flu outbreak. I won’t spoil the book for you here by telling you how much of this information Jackie learns and whether she is able to stop the pandemic.

The Science Behind Dormant

• Influenza
• Time Travel 
• Crude Oil Refining

H1N1 influenza pandemic, vaccine, and my part in the response

My fascination with nearly all things medical probably started with my mother’s stories of her work as a Labor and Delivery nurse. When I read my first account of the 1918 influenza pandemic, that fascination turned to stories related to the epidemiology of how viruses spread and the public health measures taken to prevent, when possible, or contain when not. I knew that I would see a flu outbreak in my lifetime, but I never expected to have such a close experience with the response efforts.

H1N1 Influenza A

When I began my work as a public health information specialist, I was thrilled to combine my interests with my skills. That is how, in early May 2009, I found myself elbow-deep in disseminating information related to the H1N1 pandemic. I was the smallest cog in a tremendously complex response effort—much of it done by people whose expertise I could grasp just enough to admire. Seeing the flu response unfold from inside a public health laboratory was everything and nothing like I had imagined.

H1N1 flu is a novel form of the influenza virus that first sickened humans in the United States in April 2009. In June, the World Health Organization declared that the widespread H1N1 outbreak, while unexpectedly mild to moderate, had developed into a pandemic, the term for a global outbreak.

A shortfall in influenza vaccine stocks exacerbated the 2009 pandemic. Because I was pregnant at the time, I was at the top of the vaccination priority list issued by the Centers for Disease Control and Prevention (CDC) (update 11/9/20: The priority list link for the H1N1 outbreak in 2009 has expired, but here is updated CDC info on the influenza vaccine and pregnancy). Despite this priority, there was no vaccine available. While working long hours at the flu response, my husband and I tried numerous sources to locate vaccine, including my Ob/Gyn, Primary Care Provider, work (normally a good source to promote public health preparedness), and local clinics. Months later, we finally found a source. After screening to ensure that I was a member of the priority group, a small city clinic administered the vaccine on November 5, 2009.

The beginning of December 2009 marked a real turning point for those working hard to effectively allocate the limited vaccine supply. With H1N1 vaccine availability increasing, the priority groups were expanded. By mid-December, availability again expanded. Health departments issued news releases urging everyone to get the H1N1 flu vaccination. The crisis was over.

The flu pandemic response in Dormant is based, in part, on my experiences during the H1N1 outbreak.

Mumps Outbreak Response

Most of us think of mumps as a thing of the past, if we think of it at all. But viruses tend to hibernate, mutate, and pop up again when and where we least expect. As an information specialist in public health, I see the cycle often.

Mumps is a viral infection that causes fever, headache, and inflammation of the glands under the jaw. Once a common childhood illness, mumps has been largely contained through a nation-wide vaccination program that began with the first vaccine licensed in 1967. Further information on mumps can be found via the Centers for Disease Control and Prevention (CDC) Mumps page.

In December 2010, a mumps outbreak was identified in the Texas correctional system. Inmates live in close quarters, and there is frequent movement within and between facilities—the perfect scenario for virus transmission.

Reading mumps test results

Outbreak-related specimens were sent to the Department of State Health Services Laboratory in Austin, which began testing mumps specimens on December 15, 2010. The average incidence of mumps in Texas is around 26 cases per year. In less than three months, the Viral Isolation laboratory verified mumps in 12 of the 42 submitted specimens (saliva, throat swabs, and urine). Testing was also done in the Diagnostic Serology Section; during the same time frame, three specimens (serum in specialized tubes) tested positive for mumps, of 36 specimens submitted.

This was just the beginning. Time and a second mumps outbreak in the correctional system brought the total cases to 40. The public health response was decisive and well-planned. Outbreak response plans were activated. Vaccination and quarantine halted the mumps virus before it spread through the state correctional system and beyond, to the community at large.

Samples forwarded to the CDC will be used to determine if vaccines need to be adjusted to account for a new type of mumps. Within the public health system, each outbreak is treated as a learning opportunity. We act quickly and then we analyze the process and outcome to see where we can improve.

My career in public health resulted from a personal fascination with outbreak scenarios, combined with a near-miss at becoming a nurse before obtaining an English degree. Those who work around me have varied but similar stories. Public health work progresses because we care.

My personal fascination has even turned toward my creative pursuits. Dormant is fiction, but it is science fiction based on experience. Though admittedly tweaked for storytelling purposes, my novel remains rooted in fact. What would happen if public health responders were missing or ineffective?

Should smallpox virus stocks be destroyed?

Smallpox seen through a microscope
(National Geographic Photo Gallery)

The United States Stopped routine immunizations for smallpox in 1972, three years before I was born. I was vaccinated against smallpox in 2001. Baylor College of Medicine in Houston, Texas put out a call for volunteers to test the effectiveness of diluted vaccine—randomly administered at five times dilution, 10 times dilution, and full-strength. I had a long-standing interest in the transmission and spread of viruses. I volunteered.

After the initial screening and disclosures, I was shown to a room where a doctor dipped a two-pronged needle into the vaccine and rapidly jabbed a small circle in the skin of my right shoulder. The pain was no worse than any other immunization, and I have something of a fascination with medical procedures, so I watched and gamely smiled for the press. They applied a transparent semi-permeable dressing—to protect the site and prevent exposure for those around me—and I went back to work.

About six days later, I knew that the diluted vaccine was effective. A large, itchy blister formed at the site of the vaccination. My temperature spiked and I had a persistent headache. I swallowed twoTylenol and went to see the study doctors and nurses. They took very good care of me (there was a number I could call 24/7) until I felt well again. My itchy blister became an itchy scab. I no longer needed the dressings. I went back for occasional follow-up visits for the next two months. My part of the study was done.

This week health ministers from the World Health Organization (WHO) are meeting to decide whether to destroy the final two stocks of the smallpox virus. I have been reading articles on the debate.

·      Proposed destruction of smallpox virus stirs controversy (CBS News)

·      Destruction of smallpox strains urged (UPI Science News)

·      Ministers Weighing Destruction of Final Smallpox Stocks (OH&S)

·      Decades after eradicating smallpox, countries mull whether to destroy last remaining viruses (The Washington Post)

For a fascinating and very readable account of the incredible work to eradicate the smallpox virus, I recommend reading The Demon in the Freezer, by Richard Preston. Preston also explains the battle between scientists who want to destroy all known stocks of the virus and those who want to keep them until there is a cure for smallpox.

While destroying the smallpox virus would prevent the possibility of accidental release, only the destruction of legitimate stocks of the virus would be guaranteed. The proposed destruction also means no chance of further research should there be a future epidemic. My own research has taught me the very real inevitability of the latter; the cause will not necessarily be the smallpox virus, it could be any number of others. My book, Crude Awakening, explores an influenza pandemic scenario. Though my scenario is fiction, I based it on research and experience in public health disaster planning and response. Despite this knowledge, I am still undecided. In a perfect world, I would like to see all such threats abolished, but we do not live in a perfect world.

Where do you fall in regard to the debate? Should smallpox virus stocks be destroyed?