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2. Martha Siemsen, APRN-BC Medical Investigator Bureau of Epidemiology and Public Health Informatics Kansas Department of Health and Environment CocooningNewborns Against Pertussis Our Vision – Healthy Kansans living in safe and sustainable environments

3. Recent History of Pertussis • The incidence of pertussis is up to 20-fold higher in infants too young to have completed the primary immunization series (< 6 months of age) • Pertussis-related complications and deaths occur almost exclusively in young infants • Over 75% of pertussis-infected infants acquire the infection from a household contact. Our vision - Healthy Kansans living in safe and sustainable environments

4. Who Was the Source? Our vision – Healthy Kansans living in safe and sustainable environments

5. So what is “Cocooning”? • The Global pertussis Initiative (GPI) of 2001 recommended implementation of the cocoon strategy which is defined as: “Immunization of family members and close contacts of the newborn”. • In 2006, ACIP recommended Tdap booster immunization of infant caregivers or “cocooning”. • Two groups are targeted: • Postpartum women before hospital discharge • Contacts of infants age < 1 year Our vision – Healthy Kansans living in safe and sustainable environments

6. Challenges • Cocooning is challenging to implement • New Immunization Platform • Pertussis Awareness • Two populations – Postpartum Women, Families • New Immunization Providers • Reimbursement Issues Our vision – Healthy Kansans living in safe and sustainable environments

7. Objectives • To raise pertussis awareness by educating HCPs and families of newborn infants about the potential for life-threatening pertussis in young infants • To immunize 80% of postpartum women delivering at the 4 project hospitals • To immunize 1 primary caregiver designated by the new mother • To reduce barriers in vaccinating the mother and primary caregiver Our vision – Healthy Kansans living in safe and sustainable environments

8. Those involved • Chosen based on several factors • Number of births in 2007 • VFC enrollment (Universal Hep B program through VFC) • Proximity of the Local Health Department to the hospital • Hospital within a day’s drive from KDHE • Hospital obtaining approval from administration and medical staff Our vision – Healthy Kansans living in safe and sustainable environments

9. Those Involved Continued • Franklin County Health Department • Ransom Memorial Hospital – Ottawa • Montgomery County Health Department • Coffeyville Regional Medical Center • Mercy Hospital-Independence • Dickinson County Health Department • Memorial Hospital - Abilene Our vision – Healthy Kansans living in safe and sustainable environments

10. Initial Implementation • Beginning January 2010, standing order for postpartum Tdap, unless maternal contraindication is present implemented • Tdap administered on hospital discharge • Voucher presented at pre-registration or during hospital stay to family member to receive Tdap vaccine at the local health department. Our vision – Healthy Kansans living in safe and sustainable environments

11. Results (January – June 2010) Total number of births: 527 *Includes women who have a verified vaccination history for Tdap Our vision – Healthy Kansans living in safe and sustainable environments

12. Time for a Change • Postpartum vaccination on target • Primary caregiver vaccination rate lower than expected • Time for improving processes • Barriers identified: • Fear of Needles • Time • Lost voucher Our vision – Healthy Kansans living in safe and sustainable environments

13. Process Enhancements • Develop standing order for family member vaccination prior to mother and infant discharge with key medical staff. • Method initiated to prevent the need to admit family member in order to vaccinate • Involve stake holders • Medical Records, Nursing staff, Pharmacists, Pediatricians, OB/GYN, Local Health Departments Our vision – Healthy Kansans living in safe and sustainable environments

14. Ransom Memorial Our vision – Healthy Kansans living in safe and sustainable environments

15. Future Plans • Target large hospitals in regions where pertussis is seen frequently. • Must be a VFC provider (Universal Hep B Birth Dose) • Expand to all birth hospitals statewide who are VFC providers. Our vision – Healthy Kansans living in safe and sustainable environments

16. Acknowledgements • Franklin County Health Department • Midge Ransom – Administrator • Rebecca Hastings – Immunizations • Montgomery County Health Department • Ruth Bardwell – Administrator • Carolyn Mueller – Immunizations • Dickinson County Health Department • Linda Davies – Administrator • Brenda Weaver – Immunizations • All HCP’s who care for pregnant women and their newborn infants • Ransom Memorial Hospital • Larry Felix – Administrator • Justine Fine – OB Nurse Manager • Coffeyville Memorial Hospital • Jerry Marquette – Administrator • Carla Robson – OB Nurse Manager • Memorial Hospital-Abilene • Mark A Miller – Administrator • Teresa Hudson – OB Nurse Manager • Mercy Hospital Independence • Eric Ammons - Administrator • Jenn Wintjen – OB Nurse Manager Our vision – Healthy Kansans living in safe and sustainable environments

17. References Wendelboe AM, Njamkepo E, Bourillon A, et al. Transmission of Bordetella pertussis to young infants. Pediatr Infect Dis J 2007;26:293–9. Bisgard KM, Pascual FB, Ehresmann KR, et al. Infant pertussis. Who was the source? Pediatr Infect Dis J 2004;23:985–9. Tan T, Halperin S, Cherry JD, Edwards K, Englund JA, Glezen P, Greenberg D, Rothstein E, Skowronski D. Pertussis immunization in the global pertussis initiative North American region: recommended strategies and implementation considerations, Pediatr Infect Dis J. 2005 May;24(5Supp):S83-6. MMWR, May 30, 2009/57(04);1-47,51