In its efforts to find ways to reduce the number of Pertussis cases in the U.S., the Advisory Committee on Immunization Practices (ACIP)  is examining its Tdap recommendations including who should receive the vaccine and  how often. At its tri-annual meeting held last Thursday at the CDC in Atlanta, members of the ACIP expressed concern over the low percentage of Tdap vaccinations of healthcare personnel.
CDC reports indicate the number of reported Pertussis cases in each of the last three years is at the highest rate since 1959. Evidence indicates Tdap begins to lose its effectiveness 3-4 years after vaccination which is resulting in an increase of Pertussis cases, especially in infants and children. After thirty-eight years of less than 10,000 annual cases, the number of Pertussis cases has been raising over-all since 2003.  In fact, in 2012 there were 48,277 cases reported in the U.S.
Taking these numbers into consideration, ACIP formed the Pertussis Vaccines Work Group to examine ways to research and possibly adjust vaccination recommendations to lower the number of cases.  In addition to the general public, several smaller groups have been targeted for study including pregnant women, adults over 65 and healthcare personnel. Most pregnant women are now recommended to not only get a Tdap with every pregnancy but to also make sure all those who will be in close contact with their newborn also be vaccinated (called cocooning). Additional recommendations include expanding the age indication for the Tdap vaccine to include adults age 65 and older as well as removing the time limit for healthcare personnel between their Td boosters and a Tdap.
The work group investigated recommending a second dose of Tdap for healthcare personnel but fell short of this particular recommendation. Dr. Jennifer Liang, an epidemiologist with CDC’s National Center for Immunization and Respiratory Diseases and CDC Lead for this work group, indicated that although there is a higher risk of exposure to Pertussis for healthcare personnel it is unclear if the rate of exposure causes an increase in the disease in this group. Dr. Liang went on to indicate that although there were no changes to the current Tdap recommendations for healthcare personnel, the focus on the current guidelines should increase. The guidelines state, “All HCPs who have not or are unsure if they have previously received a dose of Tdap should receive a dose of Tdap as soon as feasible, without regard to the interval since the previous dose of Td. Pregnant HCP need to get repeat doses during each pregnancy. All HCPs should then receive Td boosters every 10 years thereafter.”
The current Tdap vaccination rate for healthcare personnel is 31%, up from 27% in 2011 and 16% in 2008. However, compared to vaccination rates for other preventable diseases such as influenza, chicken pox and measles, the number is very low. Representatives from vaccine manufacturers Sanofi Pasteur and GlaxoSmithKline spoke at the recent ACIP meeting and indicated there are no new Tdap vaccines (possibly with longer-lasting immunity) on the horizon at this time due to “formidable structural barriers.” They indicated the best strategy to prevent Pertussis outbreaks would be to increase the usage rate of the current vaccines approved and on the market.
The ReptraxTM vendor credentialing service and IntelliCentrics SEC3URETM can help your facility improve Tdap and all your vaccination rates through education, communication, and tracking and measuring participation. The goal of all vaccination programs at healthcare facilities should be to provide a safer environment for patients, staff and visitors. At IntellliCentrics we share the same goal so, as a result of the recent ACIP meeting, we are adding Tdap to our Best Practice Credentials for all patient care categories.

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