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Effectiveness of Postpartum Tdap Immunization in California Hospitals

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16 diapositives · 295 Views · Jan 02, 2013

This study investigates the efficacy of postpartum Tdap vaccination in reducing pertussis transmission to infants in California hospitals. Pertussis poses a high risk for infants under three months, with significant hospitalization and mortality rates. A survey of 267 hospitals revealed that by the end of 2009, 25% had implemented postpartum Tdap policies. Results indicated a significant decline in pertussis incidence in facilities adopting these policies, suggesting that vaccinating new mothers can effectively protect vulnerable infants. Enhanced efforts are needed to encourage wide policy adoption.

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  1. Effectiveness of Postpartum Tdap Immunization in California Hospitals K. Winter, K. Harriman, R. Schechter, J. Chang, J. TalaricoCalifornia Department of Public Health

  2. 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

  3. Pertussis hospitalizations in infants <1 year, by age in weeks –California, 2008

  4. 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.

  5. 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

  6. 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

  7. 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?

  8. 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

  9. 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

  10. 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

  11. 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)

  12. 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

  13. Overall pertussis incidence in infants <4 months of age statewide and in facilities with and without a postpartum Tdap policy – California, 2006-2009

  14. 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.

  15. 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

  16. 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