'Cocooning' Problematic but May Protect Children From Illness

NEW ORLEANS – Protecting children by vaccinating parents comes with some baggage that needs to be sorted out before the idea can become a reality, according to Dr. Herschel Lessin.

There’s no longer any doubt that cocooning, or spinning a cocoon of communicable disease protection around infants and young children, does protect them from illness, said Dr. Lessin, who coauthored the American Academy of Pediatrics 2012 report on the issue (Pediatrics 2012;129:e247-53).

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The review found lots of evidence supporting the practice – including one study showing that up to half of infant pertussis cases could have been prevented if parents had been immunized (Pediatr. Infect. Dis. J. 2004;23:985-9).

Two other studies have shown a significantly reduced incidence of influenza among infants whose mothers were vaccinated during pregnancy (Am. J. Obstet. Gynecol. 2011;204[suppl. 1]:S141-8; New Engl. J. Med. 2008;359:1555-64).

Unfortunately, Dr. Lessin said, "adults’ physicians do an awful job of immunizing patients, so most adults are not fully immunized." Obstetricians and neonatal intensive care units "are good at vaccinating mom, but not dad, so these infants are clearly at risk," he added.

The pediatrician’s office can make a difference. "We’re perfectly suited to be a good place to immunize adults," said Dr. Lessin, a pediatrician in private practice in Poughkeepsie, N.Y. In fact, he said, this setup may be particularly attractive to parents who are already taking off time to bring their children in for immunizations.

"These visits represent an opportunity to immunize parents or other adult caregivers with minimal disruption for both the adults and the practice," Dr. Lessin and his colleagues wrote in the AAP report. "Immunizations represent a major focus for pediatric care, and many educational opportunities exist for the pediatrician to explain the benefits of immunization for the child and for close family contacts. Thus, convenience, physician vaccine knowledge and encouragement, and vaccine availability are strong factors for immunizing parents and close family contacts in the pediatric office."

In theory, this sounds great, Dr. Lessin said at the annual meeting of the American Academy of Pediatrics. In practice, immunizing parents can be challenging and even somewhat risky. Questions about liability, how much vaccine to purchase and administer to adults, documentation, and reimbursement remain.

He addressed each of these issues:

• Liability. The Vaccine Injury Compensation Program covers all vaccines recommended for routine use in children, regardless of the age of the person being vaccinated. Since the Tdap and influenza vaccines are recommended for children, the pediatrician who also gives them to adults would be covered.

• Vaccine supply. Offering adult immunizations would mean walking a fine line between having enough vaccine and wasting money on too much. The problem could be exacerbated in years of influenza vaccine shortage. In addition, the AAP report noted that "because nearly all privately supplied influenza vaccine is preordered months in advance, there is a risk of using the ordered supply too quickly when immunizing both close family contacts and children. ... Alternatively, too much vaccine might be ordered ... leaving practices at economic risk of unused doses. This is a significant concern, given the narrow financial margins for immunizations."

• Documentation. The pediatric office would have to document these immunizations, which would entail creating some kind of brief medical record – perhaps a vaccination card. There should probably be some communication with the adult’s primary care provider as well.

• Reimbursement. Some offices that provide adult immunizations require up-front payment, and leave insurance filing to the individual. "You need to ask yourself if you’re willing to get into the insurance hassle because you’re not the adult’s primary care doctor. It’s up to you," he said.

The AAP report also offered a few warnings about adult vaccine billing: "In most states, vaccines supplied to pediatricians by the Vaccines for Children Program may not be used for adults and certainly cannot be billed. If a practice chooses to involve itself in the insurance coverage of parents and close family contacts, it will produce a significantly increased burden that may make the provision of such services nonviable."

Dr. Lessin disclosed that he is on the speakers board of GlaxoSmithKline and the advisory boards of Merck, Novartis, and Pfizer. He is also a senior consultant for the Verden Group, a practice management company.

NEW ORLEANS – Protecting children by vaccinating parents comes with some baggage that needs to be sorted out before the idea can become a reality, according to Dr. Herschel Lessin.

There’s no longer any doubt that cocooning, or spinning a cocoon of communicable disease protection around infants and young children, does protect them from illness, said Dr. Lessin, who coauthored the American Academy of Pediatrics 2012 report on the issue (Pediatrics 2012;129:e247-53).

Design Pics

The review found lots of evidence supporting the practice – including one study showing that up to half of infant pertussis cases could have been prevented if parents had been immunized (Pediatr. Infect. Dis. J. 2004;23:985-9).

Two other studies have shown a significantly reduced incidence of influenza among infants whose mothers were vaccinated during pregnancy (Am. J. Obstet. Gynecol. 2011;204[suppl. 1]:S141-8; New Engl. J. Med. 2008;359:1555-64).

Unfortunately, Dr. Lessin said, "adults’ physicians do an awful job of immunizing patients, so most adults are not fully immunized." Obstetricians and neonatal intensive care units "are good at vaccinating mom, but not dad, so these infants are clearly at risk," he added.

The pediatrician’s office can make a difference. "We’re perfectly suited to be a good place to immunize adults," said Dr. Lessin, a pediatrician in private practice in Poughkeepsie, N.Y. In fact, he said, this setup may be particularly attractive to parents who are already taking off time to bring their children in for immunizations.

"These visits represent an opportunity to immunize parents or other adult caregivers with minimal disruption for both the adults and the practice," Dr. Lessin and his colleagues wrote in the AAP report. "Immunizations represent a major focus for pediatric care, and many educational opportunities exist for the pediatrician to explain the benefits of immunization for the child and for close family contacts. Thus, convenience, physician vaccine knowledge and encouragement, and vaccine availability are strong factors for immunizing parents and close family contacts in the pediatric office."

In theory, this sounds great, Dr. Lessin said at the annual meeting of the American Academy of Pediatrics. In practice, immunizing parents can be challenging and even somewhat risky. Questions about liability, how much vaccine to purchase and administer to adults, documentation, and reimbursement remain.

He addressed each of these issues:

• Liability. The Vaccine Injury Compensation Program covers all vaccines recommended for routine use in children, regardless of the age of the person being vaccinated. Since the Tdap and influenza vaccines are recommended for children, the pediatrician who also gives them to adults would be covered.

• Vaccine supply. Offering adult immunizations would mean walking a fine line between having enough vaccine and wasting money on too much. The problem could be exacerbated in years of influenza vaccine shortage. In addition, the AAP report noted that "because nearly all privately supplied influenza vaccine is preordered months in advance, there is a risk of using the ordered supply too quickly when immunizing both close family contacts and children. ... Alternatively, too much vaccine might be ordered ... leaving practices at economic risk of unused doses. This is a significant concern, given the narrow financial margins for immunizations."

• Documentation. The pediatric office would have to document these immunizations, which would entail creating some kind of brief medical record – perhaps a vaccination card. There should probably be some communication with the adult’s primary care provider as well.

• Reimbursement. Some offices that provide adult immunizations require up-front payment, and leave insurance filing to the individual. "You need to ask yourself if you’re willing to get into the insurance hassle because you’re not the adult’s primary care doctor. It’s up to you," he said.

The AAP report also offered a few warnings about adult vaccine billing: "In most states, vaccines supplied to pediatricians by the Vaccines for Children Program may not be used for adults and certainly cannot be billed. If a practice chooses to involve itself in the insurance coverage of parents and close family contacts, it will produce a significantly increased burden that may make the provision of such services nonviable."

Dr. Lessin disclosed that he is on the speakers board of GlaxoSmithKline and the advisory boards of Merck, Novartis, and Pfizer. He is also a senior consultant for the Verden Group, a practice management company.

NEW ORLEANS – Protecting children by vaccinating parents comes with some baggage that needs to be sorted out before the idea can become a reality, according to Dr. Herschel Lessin.

There’s no longer any doubt that cocooning, or spinning a cocoon of communicable disease protection around infants and young children, does protect them from illness, said Dr. Lessin, who coauthored the American Academy of Pediatrics 2012 report on the issue (Pediatrics 2012;129:e247-53).

Design Pics

The review found lots of evidence supporting the practice – including one study showing that up to half of infant pertussis cases could have been prevented if parents had been immunized (Pediatr. Infect. Dis. J. 2004;23:985-9).

Two other studies have shown a significantly reduced incidence of influenza among infants whose mothers were vaccinated during pregnancy (Am. J. Obstet. Gynecol. 2011;204[suppl. 1]:S141-8; New Engl. J. Med. 2008;359:1555-64).

Unfortunately, Dr. Lessin said, "adults’ physicians do an awful job of immunizing patients, so most adults are not fully immunized." Obstetricians and neonatal intensive care units "are good at vaccinating mom, but not dad, so these infants are clearly at risk," he added.

The pediatrician’s office can make a difference. "We’re perfectly suited to be a good place to immunize adults," said Dr. Lessin, a pediatrician in private practice in Poughkeepsie, N.Y. In fact, he said, this setup may be particularly attractive to parents who are already taking off time to bring their children in for immunizations.

"These visits represent an opportunity to immunize parents or other adult caregivers with minimal disruption for both the adults and the practice," Dr. Lessin and his colleagues wrote in the AAP report. "Immunizations represent a major focus for pediatric care, and many educational opportunities exist for the pediatrician to explain the benefits of immunization for the child and for close family contacts. Thus, convenience, physician vaccine knowledge and encouragement, and vaccine availability are strong factors for immunizing parents and close family contacts in the pediatric office."

In theory, this sounds great, Dr. Lessin said at the annual meeting of the American Academy of Pediatrics. In practice, immunizing parents can be challenging and even somewhat risky. Questions about liability, how much vaccine to purchase and administer to adults, documentation, and reimbursement remain.

He addressed each of these issues:

• Liability. The Vaccine Injury Compensation Program covers all vaccines recommended for routine use in children, regardless of the age of the person being vaccinated. Since the Tdap and influenza vaccines are recommended for children, the pediatrician who also gives them to adults would be covered.

• Vaccine supply. Offering adult immunizations would mean walking a fine line between having enough vaccine and wasting money on too much. The problem could be exacerbated in years of influenza vaccine shortage. In addition, the AAP report noted that "because nearly all privately supplied influenza vaccine is preordered months in advance, there is a risk of using the ordered supply too quickly when immunizing both close family contacts and children. ... Alternatively, too much vaccine might be ordered ... leaving practices at economic risk of unused doses. This is a significant concern, given the narrow financial margins for immunizations."

• Documentation. The pediatric office would have to document these immunizations, which would entail creating some kind of brief medical record – perhaps a vaccination card. There should probably be some communication with the adult’s primary care provider as well.

• Reimbursement. Some offices that provide adult immunizations require up-front payment, and leave insurance filing to the individual. "You need to ask yourself if you’re willing to get into the insurance hassle because you’re not the adult’s primary care doctor. It’s up to you," he said.

The AAP report also offered a few warnings about adult vaccine billing: "In most states, vaccines supplied to pediatricians by the Vaccines for Children Program may not be used for adults and certainly cannot be billed. If a practice chooses to involve itself in the insurance coverage of parents and close family contacts, it will produce a significantly increased burden that may make the provision of such services nonviable."

Dr. Lessin disclosed that he is on the speakers board of GlaxoSmithKline and the advisory boards of Merck, Novartis, and Pfizer. He is also a senior consultant for the Verden Group, a practice management company.