MACI Meeting December 8, 2010

1. MACI MeetingDecember 8, 2010 • Tdap in postpartum settings • Review incidence • Discuss recommendations briefly • Review California study on Tdap • Share Michigan data from hospital surveys and chart reviews • List interventions that are needed

3. Recommendations from MMWRDecember 2006 "When possible, women should receive Tdap before becoming pregnant. Approximately half of all pregnancies in the United States are unplanned (165). Any woman of childbearing age who might become pregnant is encouraged to receive a single dose of Tdap if she has not previously received Tdap (see Vaccination During Pregnancy). Women, including those who are breastfeeding, should receive a dose of Tdap in the immediate postpartum period if they have not previously received Tdap. The postpartum Tdap should be administered before discharge from the hospital or birthing center. If Tdap cannot be administered before discharge, it should be administered as soon as feasible."   

4. Tdap – Current Recommendations MMWR 2006; 55(RR-17) • Routine vaccination (1 dose) at 11-12 years of age • All persons 13 through 64 years with emphasis on • All healthcare providers • All persons with household or other close contact with infants younger than 12 months of age (parents, siblings, babysitters, etc)

5. New Tdap Recommendations* *These recommendations are provisional until published in Morbidity and Mortality Weekly Report (MMWR). Publication anticipated in December 2010. Persons aged 7 through 10 years who are not fully immunized against pertussis (including those never vaccinated or with unknown pertussis vaccination status) should receive a single dose of Tdap Adults 65 years and older who have or who anticipate having close contact with an infant younger than 12 months of age and who have not previously received Tdap should receive a single dose of Tdap Tdap can be administered regardless of the interval since the last tetanus and diphtheria containing vaccine

6. 2010 Tdap Vaccination Policy Survey-California Hospital Infection Preventionists and Labor & Delivery Managers surveyed; 202 responses to date 31% with L&D units have postpartum Tdap policy (by April 2010) 38% of facilities with an ER offer Tdap 11% of facilities with an NICU have a policy to offer vaccine to parents/siblings of NICU patients 26% offer Tdap to HCWs; all California hospitals and outpatient medical facilities will be required to offer Tdap as of September 1, 2010 under Cal/OSHA’s aerosol-transmissible disease standard Barriers: Cost of vaccine/reimbursement issues Physician/staff resistance Determination of patient eligibility

7. Evaluation of Postpartum Tdap PoliciesCalifornia • Pertussis cases in infants less than 4 months of age born from 2006-2009 were matched to birth certificates to determine birth hospital • In facilities with a postpartum Tdap vaccination policy, incidence declined significantly after policy implementation • Before Tdap policy: 39.1 cases/100,000 births • (95% CI 30.6-47.7) • After Tdap policy: 11.9 cases/100,000 births • (95% CI 5.9-18.0) • No significant decline in cases occurred in hospitals without a postpartum Tdap vaccination policy

8. Hospital Vaccine Policy/Administration 2010 Survey and 2008-10 Chart ReviewsPerinatal HepB Program • 2010 Hospital Surveys conducted by phone/fax • 42% have written policies to give Tdap vaccine to post-partum women • 2008-10 Chart Reviews • See next slide

9. Hospital Vaccine Policy/Administration 2010 Survey and 2008-10 Chart ReviewsPerinatal HepB Program Vaccinations received by post partum women in Michigan Hospitals (n=85); data obtained via chart review

10. Past MACI Meeting Discussion • Cost of vaccination listed as a barrier to Tdap postpartum –not part of the DRG code • Invite hospital organization (MHA) and health plan organization (MAHP) to discuss • Education of postpartum nurses is needed

11. Tdap in Postpartum Settings • Next Steps in Michigan