title: Cocooning:  a concept to protect young children from infectious diseases.
abstract: OBJECTIVE
  Despite focused efforts aimed at preventing infectious diseases among infants, recent years have seen a surge of infections among this population, particularly in pertussis, reminiscent of the 1940s prevaccine era. Given these trends, this review serves to discuss cocooning for infants against pertussis and its more recent application in influenza, and the barriers to and facilitators of this important strategy.
  
  
  RESULTS
  Infection with pertussis and influenza remains a significant cause of hospitalization among infants aged less than 1 year. Simultaneously, uptake of both tetanus, diphtheria, and acellular pertussis (Tdap) and influenza vaccines is very low among adults reporting close contact with an infant. To date, widespread implementation of cocooning has been thwarted by both individual-level and system-level issues, although general acceptance of vaccination is high in settings in which cocooning is encouraged.
  
  
  CONCLUSIONS
  Better characterization and improvement of the cocooning strategy are necessary. Additionally, longitudinal research evaluating the effectiveness of cocooning against pertussis and influenza is essential. Ultimately, the effectiveness of cocooning to produce sustained control of infections will be dependent on healthcare provider advocacy, patient education, implementation and enforcement of policies, and the development of cost-effective programs.
authors.affiliation: Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA.
authors.forename: Alexandra P
authors.initials: AP
authors.lastname: Grizas
authors.forename: Deepa
authors.initials: D
authors.lastname: Camenga
authors.forename: Marietta
authors.initials: M
authors.lastname: Vázquez
mesh_terms: D002675:Child, Preschool; D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007115:Immunization Schedule; D007223:Infant; D007231:Infant, Newborn; D007252:Influenza Vaccines / Q000008:administration & dosage; D007251:Influenza, Human / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control*; D008297:Male; D010342:Patient Acceptance of Health Care; D014917:Whooping Cough / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control*
chemical_list: D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines; D007252:Influenza Vaccines