Dear VaccineSmarts,

I’m going to be a grandmother for the first time. It’s an exciting time for my family. My friends (all grandmothers) tell me that I’m supposed to get some vaccines to protect the baby. What vaccines do I need?

Santa Fe, Texas

Dear Donna,

The strategy of protecting babies by vaccinating family and caretakers is called cocooning. Typically, cocooning is recommended for the prevention of whooping cough (pertussis) and the flu in infants. Both of these diseases, spread through coughing and sneezing, are particularly severe in babies due to their small airways, weak respiratory muscles and lack of immunity.

Whooping cough frequently causes pneumonia in babies and can cause inflammation of the brain along with seizures. About half of babies younger than one who get whooping cough are hospitalized, and one or two in each 100 hospitalized die. While some people feel the flu as no big deal, in babies it frequently causes wheezing, breathing and eating difficulties and may result in hospitalization and rarely death.

The immaturity of their immune system places babies at risk for most of their first year of life. Babies must receive three doses of the whooping cough vaccine and two doses of the flu vaccine for maximum protection. Because it takes about a month for the effect of a vaccine to kick in, even babies on schedule are not fully protected from whooping cough until seven months of age. The flu vaccine is even more problematic. The baby can only receive the first dose at six months of age. The second dose is given a month after the first dose. Further complicating the picture, the flu vaccine is usually only available September through March. A baby starting the flu vaccine in September, for example, will not be protected until well into flu season. Even then, it is important to realize that the protection is not absolute.

Given that babies are vulnerable and take an extended period to vaccinate, it’s wise to cocoon. One study found that in more than 75 percent of whooping cough cases, the baby caught the disease from someone in the household. A grandparent was the responsible party in about 10 percent of cases. The number of whooping cough cases has been increasing. There were 2,374 reported cases of it in Texas last year. It’s likely the actual number of cases was far larger since it is hard to recognize whooping cough in teens and adults.

The CDC recommends that individuals anticipating close contact with a baby receive a single dose of Tdap (tetanus-diphtheria- pertussis) vaccine to protect against whooping cough. Ideally, they should get Tdap at least two weeks before beginning close contact with the infant. They should also receive the seasonal flu vaccine as soon as it becomes available.

Dr. Richard Rupp is a pediatrician and professor and Bridget Hawkins, Ph.D., is an assistant professor at UTMB. Visit their blog at or like them on Facebook or follow them on Twitter @VaccineSmarts.