Effectiveness of Postpartum Tdap Immunization in California Hospitals K. Winter, K. Harriman, R....
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Transcript of Effectiveness of Postpartum Tdap Immunization in California Hospitals K. Winter, K. Harriman, R....
![Page 1: Effectiveness of Postpartum Tdap Immunization in California Hospitals K. Winter, K. Harriman, R. Schechter, J. Chang, J. Talarico California Department.](https://reader036.fdocuments.in/reader036/viewer/2022081602/551bd07c550346be588b542d/html5/thumbnails/1.jpg)
Effectiveness of Postpartum Tdap
Immunization in California Hospitals
K. Winter, K. Harriman, R. Schechter, J. Chang, J. Talarico
California Department of Public Health
![Page 2: Effectiveness of Postpartum Tdap Immunization in California Hospitals K. Winter, K. Harriman, R. Schechter, J. Chang, J. Talarico California Department.](https://reader036.fdocuments.in/reader036/viewer/2022081602/551bd07c550346be588b542d/html5/thumbnails/2.jpg)
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
![Page 3: Effectiveness of Postpartum Tdap Immunization in California Hospitals K. Winter, K. Harriman, R. Schechter, J. Chang, J. Talarico California Department.](https://reader036.fdocuments.in/reader036/viewer/2022081602/551bd07c550346be588b542d/html5/thumbnails/3.jpg)
Pertussis hospitalizations in infants <1 year, by age in weeks – California, 2008
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![Page 4: Effectiveness of Postpartum Tdap Immunization in California Hospitals K. Winter, K. Harriman, R. Schechter, J. Chang, J. Talarico California Department.](https://reader036.fdocuments.in/reader036/viewer/2022081602/551bd07c550346be588b542d/html5/thumbnails/4.jpg)
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.
![Page 5: Effectiveness of Postpartum Tdap Immunization in California Hospitals K. Winter, K. Harriman, R. Schechter, J. Chang, J. Talarico California Department.](https://reader036.fdocuments.in/reader036/viewer/2022081602/551bd07c550346be588b542d/html5/thumbnails/5.jpg)
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
![Page 6: Effectiveness of Postpartum Tdap Immunization in California Hospitals K. Winter, K. Harriman, R. Schechter, J. Chang, J. Talarico California Department.](https://reader036.fdocuments.in/reader036/viewer/2022081602/551bd07c550346be588b542d/html5/thumbnails/6.jpg)
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Epidemic curve of pertussis cases by month of report and deaths by month of onset– California, 2009-2010
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![Page 7: Effectiveness of Postpartum Tdap Immunization in California Hospitals K. Winter, K. Harriman, R. Schechter, J. Chang, J. Talarico California Department.](https://reader036.fdocuments.in/reader036/viewer/2022081602/551bd07c550346be588b542d/html5/thumbnails/7.jpg)
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?
![Page 8: Effectiveness of Postpartum Tdap Immunization in California Hospitals K. Winter, K. Harriman, R. Schechter, J. Chang, J. Talarico California Department.](https://reader036.fdocuments.in/reader036/viewer/2022081602/551bd07c550346be588b542d/html5/thumbnails/8.jpg)
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
![Page 9: Effectiveness of Postpartum Tdap Immunization in California Hospitals K. Winter, K. Harriman, R. Schechter, J. Chang, J. Talarico California Department.](https://reader036.fdocuments.in/reader036/viewer/2022081602/551bd07c550346be588b542d/html5/thumbnails/9.jpg)
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
![Page 10: Effectiveness of Postpartum Tdap Immunization in California Hospitals K. Winter, K. Harriman, R. Schechter, J. Chang, J. Talarico California Department.](https://reader036.fdocuments.in/reader036/viewer/2022081602/551bd07c550346be588b542d/html5/thumbnails/10.jpg)
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
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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)
![Page 12: Effectiveness of Postpartum Tdap Immunization in California Hospitals K. Winter, K. Harriman, R. Schechter, J. Chang, J. Talarico California Department.](https://reader036.fdocuments.in/reader036/viewer/2022081602/551bd07c550346be588b542d/html5/thumbnails/12.jpg)
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)
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Overall pertussis incidence in infants <4 months of age statewide and in facilities with and without a postpartum
Tdap policy – California, 2006-2009
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Overall statewide incidenceTdap policyNo policy
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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.
![Page 15: Effectiveness of Postpartum Tdap Immunization in California Hospitals K. Winter, K. Harriman, R. Schechter, J. Chang, J. Talarico California Department.](https://reader036.fdocuments.in/reader036/viewer/2022081602/551bd07c550346be588b542d/html5/thumbnails/15.jpg)
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
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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