{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T18:41:39Z","timestamp":1780080099423,"version":"3.54.0"},"reference-count":30,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2024,3,18]],"date-time":"2024-03-18T00:00:00Z","timestamp":1710720000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vaccines"],"abstract":"<jats:p>Pertussis is an important cause of mortality and morbidity in infancy. It is recommended that close contacts of the baby be vaccinated with Tdap, and this practice is called the cocoon strategy. This study aimed to investigate the applicability of the cocoon strategy and to determine the factors affecting the process. Mothers of babies who were hospitalized in the neonatal intensive care unit were included in the study. In the first stage, a face-to-face questionnaire was given to the mothers to measure their level of knowledge about whooping cough and its vaccine. In the second stage, written and verbal information about the cocoon strategy was given, and then vaccination intentions for Tdap were learned. In the third stage, all mothers were contacted 3 weeks after and asked whether they had received a Tdap vaccination and why. Of these mothers, 68% could not answer any questions about pertussis disease and vaccines correctly. After the information, 35% (n = 78) of the mothers stated that they were considering getting vaccinated, while only 2% (n = 5) of the mothers were able to get the Tdap vaccine. The most important reasons for not getting vaccinated were a lack of time (24%) and the cost of vaccination (23%). It is predicted that Tdap vaccination rates may increase if the cost of vaccine, availability of vaccine, and the access of mothers to the vaccine application are facilitated.<\/jats:p>","DOI":"10.3390\/vaccines12030319","type":"journal-article","created":{"date-parts":[[2024,3,18]],"date-time":"2024-03-18T05:14:07Z","timestamp":1710738847000},"page":"319","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Factors Affecting the Implementation and Acceptance of the Cocoon Strategy in the NICU in a Tertiary Center in T\u00fcrkiye"],"prefix":"10.3390","volume":"12","author":[{"given":"\u015eeyma","family":"Karatekin","sequence":"first","affiliation":[{"name":"Department of Child Health and Disease, Faculty of Medicine, Samsun University, Samsun 55080, T\u00fcrkiye"},{"name":"Social Pediatrics Doctorate Programme, Institute of Child Health Department, \u0130stanbul University, Istanbul 34104, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Selda Han\u00e7erli","family":"T\u00f6r\u00fcn","sequence":"additional","affiliation":[{"name":"Division of Pediatric Infectious Diseases, Department of Pediatrics, \u0130stanbul Faculty of Medicine, \u0130stanbul University, Istanbul 34104, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ebru","family":"\u015eenol","sequence":"additional","affiliation":[{"name":"Social Pediatrics Doctorate Programme, Institute of Child Health Department, \u0130stanbul University, Istanbul 34104, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5761-4757","authenticated-orcid":false,"given":"Salih \u00c7a\u011fr\u0131","family":"\u00c7ak\u0131r","sequence":"additional","affiliation":[{"name":"Neonatology, Faculty of Medicine, Bursa Uluda\u011f University, Bursa 16059, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G\u00fclbin","family":"G\u00f6k\u00e7ay","sequence":"additional","affiliation":[{"name":"Department of Social Pediatrics, Institute of Child Health, \u0130stanbul University, Istanbul 34104, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,3,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"World Health Organization (WHO) (2016). Pertussis Vaccines: WHO Position Paper, August 2015--Recommendations. Vaccine, 34, 1423\u20131425.","DOI":"10.1016\/j.vaccine.2015.10.136"},{"key":"ref_2","unstructured":"Kimberlin, D.W., Barnett, E.D., Lynfield, R., and Sawyer, M.H. (2021). Red Book: Report of the Committee on Infectious Diseases 2021, American Academy of Pediatrics."},{"key":"ref_3","unstructured":"Kathryn, M., and Edwards, M.D.D. (2018). Plotkin\u2019s Vaccines, Elsevier."},{"key":"ref_4","first-page":"54","article-title":"The Clinical Characteristics and Prognosis of Pertussis among Unvaccinated Infants in Pediatric Intensive Care Unit","volume":"55","author":"Annayev","year":"2020","journal-title":"Turk. Arch. Pediatr."},{"key":"ref_5","first-page":"426","article-title":"Fulminant Pertussis in Very Young Infants: Two Cases and Review of the Literature","volume":"55","author":"Paksu","year":"2013","journal-title":"Turk. J. Pediatr."},{"key":"ref_6","unstructured":"Beyazova, U., and Karaka\u015f, N.M. (2021). Child Health Follow-Up First Five Years of Age, Nobel T\u0131p Kitabevi."},{"key":"ref_7","first-page":"1","article-title":"Preventing Tetanus, Diphtheria, and Pertussis among Adults: Use of Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccine Recommendations of the Advisory Committee on Immunization Practices (ACIP) and Recommendation of ACIP, Supported B","volume":"55","author":"Kretsinger","year":"2006","journal-title":"MMWR Recomm. Rep."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1","DOI":"10.15585\/mmwr.rr6702a1","article-title":"Prevention of Pertussis, Tetanus, and Diphtheria with Vaccines in the United States: Recommendations of the Advisory Committee on Immunization Practices (ACIP)","volume":"67","author":"Liang","year":"2018","journal-title":"MMWR Recomm. Rep."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1097\/MOP.0b013e32834e8fe9","article-title":"Cocooning","volume":"24","author":"Grizas","year":"2012","journal-title":"Curr. Opin. Pediatr."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e1475","DOI":"10.1542\/peds.2014-3925","article-title":"Strategies to Decrease Pertussis Transmission to Infants","volume":"135","author":"Forsyth","year":"2015","journal-title":"Pediatrics"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1165","DOI":"10.1080\/21645515.2015.1019188","article-title":"Maternal Uptake of Pertussis Cocooning Strategy and Other Pregnancy Related Recommended Immunizations","volume":"11","author":"Wong","year":"2015","journal-title":"Hum. Vaccin. Immunother."},{"key":"ref_12","unstructured":"Centers for Disease Control and Prevention (CDC) (2011). Updated Recommendations for Use of Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccine (Tdap) in Pregnant Women and Persons Who Have or Anticipate Having Close Contact with an Infant Aged <12 Months\u2014Advisory Committee on Immuniza. MMWR Morb. Mortal. Wkly. Rep., 60, 1424\u20131426."},{"key":"ref_13","unstructured":"(2024, February 10). Republic of T\u00fcrkiye Ministry of Health Expanded Program on Immunization, Available online: https:\/\/covid19asi.saglik.gov.tr\/TR-77803\/genisletilmis-bagisiklama-programi-gbp.html."},{"key":"ref_14","unstructured":"World Health Organization (WHO) (2014). Report of the Sage Working Group on Vaccine Hesitancy, World Health Organization (WHO)."},{"key":"ref_15","first-page":"225","article-title":"The Impact of Early Postpartum Maternal Pertussis Vaccination on the Protection of Infants: A Randomized Clinical Trial","volume":"16","author":"Yener","year":"2019","journal-title":"Iran. J. Immunol."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Donnan, E.J., Fielding, J.E., Rowe, S.L., Franklin, L.J., and Vally, H. (2013). A Cross Sectional Survey of Attitudes, Awareness and Uptake of the Parental Pertussis Booster Vaccine as Part of a Cocooning Strategy, Victoria, Australia. BMC Public Health, 13.","DOI":"10.1186\/1471-2458-13-676"},{"key":"ref_17","unstructured":"Republic of T\u00fcrkiye Ministry of Health Public Health, Directorate (2018). Prenatal Care Guide."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"316","DOI":"10.3906\/sag-1910-23","article-title":"Different Perspectives of Immunizations during Pregnancy","volume":"50","author":"Celep","year":"2020","journal-title":"Turk. J. Med. Sci."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"5641","DOI":"10.1016\/j.vaccine.2010.05.078","article-title":"Factors Influencing Women\u2019s Decisions Regarding Pertussis Vaccine: A Decision-Making Study in the Postpartum Pertussis Immunization Program of a Teaching Hospital in Taiwan","volume":"28","author":"Cheng","year":"2010","journal-title":"Vaccine"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1016\/j.vaccine.2013.12.054","article-title":"Intention to Accept Bordetella Pertussis Booster Vaccine during Pregnancy in Mexico City","volume":"32","author":"Varan","year":"2014","journal-title":"Vaccine"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1101","DOI":"10.1080\/21645515.2019.1689082","article-title":"Knowledge and Acceptance of Influenza and Pertussis Vaccinations among Pregnant Women of Low Socioeconomic Status in Turkey","volume":"16","author":"Yakut","year":"2020","journal-title":"Hum. Vaccin. Immunother."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"412","DOI":"10.4274\/nkmj.galenos.2022.30074","article-title":"Pertussis Awareness and Vaccination Status of Healthcare Workers in the Neonatal Intensive Care Unit","volume":"10","author":"Karatekin","year":"2022","journal-title":"Nam\u0131k Kemal T\u0131p Derg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1016\/j.medmal.2016.03.005","article-title":"Pertussis Vaccination Coverage among French Parents of Infants after 10 years of Cocoon Strategy","volume":"46","author":"Cohen","year":"2016","journal-title":"Med. Mal. Infect."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Costantino, C., Mazzucco, W., Bonaccorso, N., Cimino, L., Conforto, A., Sciortino, M., Catalano, G., D\u2019Anna, M.R., Maiorana, A., and Venezia, R. (2021). Educational Interventions on Pregnancy Vaccinations during Childbirth Classes Improves Vaccine Coverages among Pregnant Women in Palermo\u2019s Province. Vaccines, 9.","DOI":"10.3390\/vaccines9121455"},{"key":"ref_25","first-page":"16","article-title":"The Factors Affecting Vaccination Acceptance","volume":"16","author":"Yetim","year":"2016","journal-title":"J. Child."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e550","DOI":"10.1542\/peds.2008-0813","article-title":"Administration of Tetanus, Diphtheria, and Acellular Pertussis Vaccine to Parents of High-Risk Infants in the Neonatal Intensive Care Unit","volume":"122","author":"Dylag","year":"2008","journal-title":"Pediatrics"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1093\/cid\/ciq001","article-title":"Implementation of Cocooning against Pertussis in a High-Risk Population","volume":"52","author":"Healy","year":"2011","journal-title":"Clin. Infect. Dis."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1177\/003335491412900306","article-title":"Protecting Newborns by Immunizing Family Members in a Hospital-Based Vaccine Clinic: A Successful Tdap Cocooning Program during the 2010 California Pertussis Epidemic","volume":"129","author":"Rosenblum","year":"2014","journal-title":"Public Health Rep."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1016\/j.vaccine.2014.10.074","article-title":"What Predicts Postpartum Pertussis Booster Vaccination? A Controlled Intervention Trial","volume":"33","author":"Hayles","year":"2015","journal-title":"Vaccine"},{"key":"ref_30","first-page":"144","article-title":"Factors Affecting the Immunization Approaches of Caregivers: An Example of a Teaching and Research Hospital","volume":"13","year":"2019","journal-title":"J. Pediatr. Infect."}],"container-title":["Vaccines"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-393X\/12\/3\/319\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:15:14Z","timestamp":1760105714000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-393X\/12\/3\/319"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,18]]},"references-count":30,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2024,3]]}},"alternative-id":["vaccines12030319"],"URL":"https:\/\/doi.org\/10.3390\/vaccines12030319","relation":{},"ISSN":["2076-393X"],"issn-type":[{"value":"2076-393X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3,18]]}}}