Strategies for Vaccination of Close Contacts and Expectant Parents of Infants:  The Next Immunization Frontier for Pediatricians

Considerable evidence suggests that infants are at risk for vaccine-preventable diseases from their close adult and sibling contacts. In the young vulnerable host, these pathogens lead to significantly increased morbidity and mortality. Yet, undervaccination of close contacts remains a persistent problem and contributes to pediatric infection. This article argues for greater involvement of pediatric health care workers in adult immunization. Evidence-based strategies that increased vaccination in this population are reviewed, and a multiphased approach incorporating all caregivers is outlined. Cooperation of health care providers from obstetrics, internal medicine, pediatrics, and pediatric subspecialties is required to ultimately achieve “cocoon immunity” (vaccination of all close contacts in a household to protect an unimmunized infant). Development of these strategies requires elimination of financial, medicolegal, and logistic barriers.