title: A 'cocoon immunization strategy' among patients with inflammatory bowel disease.
abstract: OBJECTIVE
  A 'cocoon strategy' is defined as the strategy of protecting vulnerable patients from infectious diseases by vaccinating those in close contact with them. In our study, we evaluate the vaccination status among children living with patients with inflammatory bowel disease (IBD) to determine the realization of the cocoon strategy and to identify characteristics associated with pediatric vaccine refusal.
  
  
  METHODS
  A self-completed survey was conducted on 136 hospitalized patients with IBD. The survey comprised questions about household child vaccination coverage, the reasons for vaccine refusal, and the history of infectious diseases among the patients.
  
  
  RESULTS
  Fifty-six patients reported living with children. Forty percent of children were vaccinated with at least one of the recommended vaccines. Most frequently, children received pneumococcal (26%) and rotaviruses (22%) vaccines. The most common reason for nonimmunization was patients' opinion that immunizations are not necessary for them (52%). There was a statistically significant association between the nonreimbursed vaccines coverage and the educational level of the patients (P<0.0001). Despite the fact that 28% of the patients could not definitively recall varicella infection, none of them and none of the children in their household had been vaccinated against chickenpox.
  
  
  CONCLUSIONS
  The use of nonmandatory vaccines recommended in family members of patients with IBD is insufficient. Further vaccine promotion and education of patients as well as their healthcare providers is required. A particular concern is associated with the pneumococcal, influenza, rotaviruses, and varicella infections. Nonimmunized and varicella-zoster virus-seronegative patients should be vaccinated, and in case of immunosuppression, vaccination of children in the household is required.
authors.affiliation: Departments of aPediatrics and Infectious Diseases bGastroenterology and Hepatology, Wroclaw Medical University, Wroclaw, Poland.
authors.forename: Karolina
authors.initials: K
authors.lastname: Waszczuk
authors.forename: Ewa
authors.initials: E
authors.lastname: Waszczuk
authors.forename: Agata
authors.initials: A
authors.lastname: Mulak
authors.forename: Leszek
authors.initials: L
authors.lastname: Szenborn
authors.forename: Leszek
authors.initials: L
authors.lastname: Paradowski
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003657:Decision Making; D004522:Educational Status; D005192:Family Health; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007223:Infant; D007231:Infant, Newborn; D015212:Inflammatory Bowel Diseases / Q000150:complications* / Q000276:immunology; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000150:complications / Q000517:prevention & control*; D010290:Parents / Q000523:psychology; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011044:Poland; D014611:Vaccination / Q000592:standards / Q000706:statistics & numerical data*; D055815:Young Adult