Effectiveness of Postpartum Tdap Immunization in California Hospitals by yurtgc548

VIEWS: 3 PAGES: 16

									 Effectiveness of Postpartum
    Tdap Immunization in
     California Hospitals


K. Winter, K. Harriman, R. Schechter, J. Chang, J. Talarico
          California Department of Public Health
Background – Pertussis in infants

• Pertussis is an acute and prolonged cough illness
  caused by Bordetella pertussis
• Most severe disease occurs in infants <3 months
  of age
  § >60% of infected infants <1 year are hospitalized
  § All pertussis deaths in CA since 1998 have been in
    infants <3 months of age (n=43)
• Infants do not start DTaP series until 2 months of
  age and are not fully protected until 18 months
Pertussis hospitalizations in infants <1 year,
     by age in weeks – California, 2008
  Background – Postpartum Tdap

  • Source of pertussis infection in infants has been
    linked to parents, most often mothers, in 20%-
    55% of cases*
  • First pertussis vaccine for adolescents and
    adults licensed in 2005 (Tdap)
  • Advisory Committee for Immunization Practices
    recommended vaccination of close contacts of
    infants as part of ‘cocooning’ strategy in 2006
*Bisgard KM, et al. Infant pertussis: who was the source? Pediatr
Infect Dis J 2004; 23(11):985-989.
Wendelboe AM, et al. Transmission of Bordetella pertussis to young
infants. Pediatr Infect Dis J 2007; 26(4):293-299.
Background – Pertussis on the rise

• Pertussis is cyclical with peaks occurring every 3-
  5 years.
• Last peak occurred in 2005 when >3,000 cases
  were reported and 8 infants died in California
• Data suggests that 2010 will be another peak
  year in California
   § 3 times as many cases were reported from January 1-
     May 31, 2010 as the same period in 2009
   § 5 infants have died, all <3 months of age
• This year we have an intervention: Tdap
Epidemic curve of pertussis cases by month of report and
    deaths by month of onset– California, 2009-2010
                     X

                                                  X 2009 death
                                                  X 2010 death
                                    X
                X
     X
     X    X                              X
                                              X
Study Questions

• Is postpartum Tdap vaccination an effective
  strategy to reduce transmission of B. pertussis
  to young infants?
• How many birthing facilities in California have
  policies to administer Tdap vaccine to
  postpartum women?
Methods
• Distributed survey to Infection Preventionists and Labor and
  Delivery Managers at California hospitals with >50
  births/year (n=267)
   § Does facility have a postpartum Tdap policy?
   § When (month/year) was it implemented?
   § Also obtained a brief description of the policy and description of any
     barriers to implementation
• Attempted to identify birth hospital for all reported pertussis
  cases <4 months of age born 2006-2009 in California
   § For cases born 2006-2008: Matched pertussis cases to birth record
     (vital statistics) using name and DOB to identify birth hospital
   § For cases born 2009: Birth hospital reported on case report form
Methods, continued

• Calculated annual rate of pertussis among infants
  born in each facility (# cases/total births)
• Compared pertussis incidence before and after
  Tdap policy implementation
  § If month of implementation was unknown, assumed to
    be January
• Evaluated incidence over time in all hospitals
Results
• 744 infants <4 months of age were infected with
  pertussis
  § 537 (72%) hospitalized
  § 10 (1%) died
  § Hospital of birth identified in 620 (83%)
• 214 of 267 (80%) facilities with >50 births
  responded to survey
  § 53 (25%) implemented a postpartum Tdap policy by
    the end of 2009
  § First Tdap policy was implemented in January 2007
  § 161 (controls) had no policy or were in process of
    implementation
Results, continued
• Pertussis incidence after postpartum Tdap policy
  implementation:
   § Declined or remained at 0 in 42 (79%) facilities
   § Increased in 11 (21%) facilities
• Overall incidence in all facilities with a Tdap policy
  declined significantly after policy implementation
   § Before Tdap policy: 41.7 cases/100,000 births
     (95% CI 34.4-49.0)
   § After Tdap policy: 19.2 cases/100,000 births       (95%
     CI 12.7-25.6)
Results, continued
• Pertussis incidence over time also declined significantly
  in hospitals with a postpartum Tdap vaccination policy
  from 2006 (when no postpartum Tdap policies existed)
  to 2009 (when 53 policies existed)
• Increase in incidence was observed in control hospitals
                                 2006                2009
       Hospitals with Tdap
             policy (n=48)   46.8 (34.1-59.5)   23.8 (14.7-33.0)
    Hospitals with no Tdap
            policy (n=145)   29.7 (23.7-35.8)   35.7 (29.0-42.3)
Overall pertussis incidence in infants <4 months of age statewide
  and in facilities with and without a postpartum Tdap policy –
                       California, 2006-2009
Conclusions

• Decline in pertussis incidence observed in
  facilities with a postpartum Tdap vaccination
  policy suggests that vaccinating new mothers
  may reduce transmission to infants.
• Although recommended in 2006, only ¼ of
  birthing hospitals had implemented a
  postpartum Tdap policy by 2009. Additional
  efforts are needed to encourage facilities to
  adopt cocooning policies.
Data limitations

• Pertussis incidence for infants born late in 2009
  incomplete (onset in 2010)
• Vaccine uptake in facilities with a Tdap policy was
  unknown
• Maternal vaccination status for infant cases
  unknown
Recommendations

• To increase postpartum Tdap uptake, CDPH is
  now recommending no minimum interval
  between Td and Tdap
• CDPH also providing a limited quantity of free
  Tdap vaccine to birthing facilities to help
  establish cocooning programs
• Include hospital of birth on case report form for
  infants <1 year of age
  § Identify hospitals with highest rates of pertussis and
    encourage to adopt postpartum Tdap policies

								
To top