'No Vax, No Visit' not necessary: baby is probably already protected against whooping cough

NO VAX, NO VISIT! Our baby girl is due in four weeks. We can’t wait to meet her! If you would like to meet her, we ask that you ask your doctor for a whooping cough booster this week. Our daughter can’t receive her first vaccination until she’s six weeks old, so relies on us to keep her safe from germs. #NoVaxNoVisit

Have you seen these requests in your social media feeds recently?

No Vax, No Visit is a movement being propagated through social media and social pressure. Expectant parents are demanding that all visitors who wish to visit their newborn are recently vaccinated against whooping cough. If visitors can’t prove they’re vaccinated, they’re refused permission to visit the baby in hospital or at home until after the newborn’s two-month vaccination (which can be given at six weeks).

It is understandable that prospective parents, aware of how devastating whooping cough can be, want to leave no stone unturned to protect their baby. But is it supported by the best evidence?

No Vax, No Visit is an unofficial extension of the “cocooning” strategy, recommended by the Australian Immunisation Handbook since 2003.

The official cocooning recommendation is to vaccinate regular household contacts if they haven’t had a whooping cough booster within the last ten years. This strategy targets parents, siblings, grandparents and anyone who is in regular contact with babies, as they are the most common sources of infection in newborns.

The cocooning recommendation doesn’t mean that anyone who comes through the front door to visit and say a quick hello must be vaccinated. It doesn’t mean regular household contacts need to be vaccinated for every child born within those ten years.

Although the idea of creating a “cocoon” of protection around babies is attractive, this approach has limitations. And eliminating all possible sources of whooping cough this way just isn’t possible.

So, what should parents do?

Evidence became available in 2014 that showed if mums are vaccinated during pregnancy, the vaccine is 91% effective in preventing severe whooping cough in very young infants.

When a mum is vaccinated during pregnancy, the protective antibodies travel across the placenta and into the baby. It’s essentially a baby’s first vaccine, so the baby is born with an army of antibodies ready for defence.

Contrary to the American vaccine insert, many studies, such as this one, have actually tested the vaccine on tens of thousands of pregnant women. The studies demonstrate how effective and safe this is for pregnant mums and their unborn child. Subsequently, in March 2015, the Australian Immunisation Handbook began recommending that women who are between 28 and 32 weeks pregnant receive a whooping cough booster for each pregnancy.

If mums follow this pregnancy recommendation, the vaccination of all visitors (in addition to regular household contacts) could theoretically offer a small amount of additional protection for the baby. However, there’s no evidence to say this is the case. The person more likely to benefit is the one receiving the vaccination, particularly if they are elderly.

Social consequences

Important things to consider with No Vax, No Visit are the unintended social consequences.

While some parents will find their family and friends are happy to be vaccinated, we are also hearing stories of isolation of new parents, division in social groups, and guilt of friends feeling irresponsible. Some new parents are even too scared to take their baby to the “disease-riddled” shopping centre, school or playground.

What seems to be forgotten is the high level of protection the baby already has if mum was vaccinated while pregnant.

While there’s no evidence that No Vax, No Visit will offer any additional protection for the newborn, there is evidence that social isolation can lead to postnatal depression. This is particularly important when we consider one in seven new mothers in Australia experiences postnatal depression.

Support for new parents is most needed during the newborn’s first few weeks of life. If new parents don’t have any visitors and are too scared to go out into the world with their newborn, what effect will this have on the family’s wellbeing?

So, what else can parents do to protect their newborn before the six-week vaccination if mum was vaccinated during pregnancy, and dad, siblings and grandparents are all up to date with their vaccines? Ask visitors to postpone their visit if they are sick, and hand-washing before cuddles is essential.

With all this in place, there’s little or no extra benefit from No Vax, No Visit.