**Author details**

Cocooning doses may reduce the serious morbidity of the infant, but timing is crucial, and the overall impact and cost-effectiveness may vary between countries and situations. The advantages of cocooning are better acceptance of vaccination in the postpartum period than during pregnancy, accessibility to the whole family, and the opportunity for health education. Disadvantages are the slow response to produce immunity to protect the newborn and logistical and economic issues. In addition, the challenges to implementing cocooning strategies include parental refusal, political hardship, logistical issues, and cultural issues. The cost–benefit ratio of cocooning is lower than maternal immunization, since it requires only one dose, whereas the cocooning strategy requires at least two doses for both parents [3, 61]. Vaccination of pregnant women is likely to be the most cost-effective additional strategy to prevent pertussis disease in young infants and appears to be more effective and favorable

In countries that have implemented pertussis vaccination for adults, vaccination of healthcare workers should be given priority, but there is no evidence that this decreases the acquisition or transmission of the disease but otherwise avoids nosocomial disease transmitted to newborns and young infants. Health professionals in contact with pregnant women, parturients, newborns, and young infants should also be prioritized. New studies are needed to assess the

Health education programs are needed to improve adherence to the pertussis immunization programs. Scientific divulgation of the disease and its prevention strategies are fundamental. Vaccination, especially for pregnant women and young infants, must also be publicized, as well as the discussion for incorporation of the vaccine against pertussis into the vaccination

Vaccination for pertussis has had a major impact in reducing the overall burden of the disease, with a general reduction in its incidence and, in particular, a reduction in infant mortality. Nevertheless, the cyclic and recurrent patterns of whooping cough are still observed in countries with high vaccine coverage. New vaccination schemes against pertussis have been developed to reduce the risk of serious illness in young infants and young children. It is necessary that all children worldwide, including HIV-positive individuals, be immunized against pertussis, and every country should seek to reach the entire population with anti-pertussis vaccination and also maintain high coverage (≥90%) at all levels (national and district).

Both the wP and aP vaccines are effective in reducing infant mortality, highlighting the importance of timely vaccination and the need to maintain high coverage, as current data point to a decrease in aP-related immunity. One future challenge may be the improvement of new vaccines considering all these factors, as well as the importance of the production of vaccines

against parapertussis, which seems to be more frequent than originally imagined.

than the cocooning strategy.

36 Pertussis - Disease, Control and Challenges

**3.6. Healthcare professionals: booster schedule**

programs for adolescents, adults, and the elderly.

real impact of this measure [16, 44, 62].

**4. Conclusions**

Filumena Maria da Silva Gomes\*, Maria Helena Valente, Ana Maria de Ulhôa Escobar and Sandra Josefina Ferraz Ellero Grisi

\*Address all correspondence to: filumena.gomes@fm.usp.br

Department of Pediatrics, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
