elizabeth lawlor, ms epidemiologist coauthor: martha siemsen, arnp-bc, medical investigator
DESCRIPTION
Lessons Learned in Implementing a Cocoon Program to Prevent Infant Pertussis at Four Kansas Hospitals. Elizabeth Lawlor, MS Epidemiologist Coauthor: Martha Siemsen, ARNP-BC, Medical Investigator Bureau of Epidemiology and Public Health Informatics Kansas Department of Health and Environment. - PowerPoint PPT PresentationTRANSCRIPT
Lessons Learned in Implementing a Cocoon Program to Prevent Infant Pertussis at Four
Kansas Hospitals
Elizabeth Lawlor, MSEpidemiologist
Coauthor: Martha Siemsen, ARNP-BC, Medical InvestigatorBureau of Epidemiology and Public Health Informatics
Kansas Department of Health and Environment
What is pertussis?
• Caused by bacterium Bordetella pertussis• Known as whooping cough• Highly contagious• Symptoms: uncontrollable, violent coughing –
can result in difficulty breathing• Can be fatal• Immunization can be used to protect against
pertussis
Number diagnosed with Pertussisby age group, United States 1997-2000
<6 months
6-11 months
1-4 years 5-9 years 10-19 years
≥20 years0
1000
2000
3000
4000
5000
6000
7000
8000
9000
Age Group
Num
ber d
iagn
osed
with
per
tuss
is
Centers for Disease Control and Prevention. Pertussis – United States, 1997-2000. MMWR 2002; 51: 73-76.
Hospitalizations due to Pertussisby age group, United States 1997-2000
<6 months
6-11 months
1-4 years 5-9 years 10-19 years
≥20 years0
1000
2000
3000
4000
5000
6000
7000
8000
9000
0
10
20
30
40
50
60
70
80
90
Age Group
Num
ber d
iagn
osed
with
per
tuss
is
Perc
ent
hosp
italiz
ed
Centers for Disease Control and Prevention. Pertussis – United States, 1997-2000. MMWR 2002; 51: 73-76.
Pneumonia Secondary to Pertussis by age group, United States 1997-2000
<6 months
6-11 months
1-4 years 5-9 years 10-19 years
≥20 years0
1000
2000
3000
4000
5000
6000
7000
8000
9000
0
2
4
6
8
10
12
14
16
18
Age Group
Num
ber d
iagn
osed
with
per
tuss
is
Perc
ent d
iagn
osed
with
pne
umon
ia
Centers for Disease Control and Prevention. Pertussis – United States, 1997-2000. MMWR 2002; 51: 73-76.
Mortality due to Pertussis by age group, United States 1997-2000
<6 months
6-11 months
1-4 years 5-9 years 10-19 years
≥20 years0
1000
2000
3000
4000
5000
6000
7000
8000
9000
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
Age Group
Num
ber d
iagn
osed
with
per
tuss
is
Perc
ent
mor
talit
y
Centers for Disease Control and Prevention. Pertussis – United States, 1997-2000. MMWR 2002; 51: 73-76.
Rise of Pertussis Cases Reported to the CDC
Centers for Disease Control and Prevention. Summary of Notifiable Diseases, 1994-2004. http://www.cdc.gov/osels/ph_surveillance/nndss/annsum/index.htm
1994 2000 2003 20040
5000
10000
15000
20000
25000
30000Pertussis in all patientsPertussis in children < 4years of age
Year
Num
ber o
f Con
firm
ed a
nd P
roba
ble
Case
s
Who Was the Source?
47%
20%
8%
25%
2004 Study
56%16%
6%
22%
2007 Study
Parent OtherGrandparentSibling
Bisgard et al. Infant pertussis: who was the source? Pediatr Infect Dis J. 2004; 23: 985-9.
Wendelboe et al. Transmission of Bordetella pertussis to Young Infants. Pediatr Infect Dis J. 2007; 26:293-299.
Cocooning
• 2001 - The Global Pertussis Initiative (GPI) recommended cocooning: – Immunization of family members and close contacts of the
newborn• 2006 - ACIP recommended Tdap booster
immunization• Two groups are targeted:– Postpartum women before hospital discharge– Contacts of infants age < 1 year
Objectives of Pilot Program
• Increase pertussis awareness through education– Health care providers– Families of newborns
• To immunize 80% of postpartum women delivering at project hospitals
• To immunize 1 primary caregiver designated by the new mother
The chosen ones
• Number of births• Vaccines for Children
(VFC) enrollment • Location• Willingness to
participate
Initial Implementation
• January 2010: Presentations to hospitals and local health departments
• Goals:– Mom • Standing orders for postpartum Tdap• Tdap administered on hospital discharge
– Caregiver• Voucher given during pre-registration or during
hospital stay
Voucher
Pertussis Vaccine VoucherMom’s Initials: ____________ Date: ___________Relationship to newborn: Parent Grandparent Other _________Franklin County Health Department1418 South Main St, Ottawa, KS (785) 229-3530M, T, R, F 7 – 4:30, W 7 – 6:15
Results (January – June 2010)
Total number of births: 248
Post Partum Women
Number Vaccinated
Percent Vaccinated
208 83.9%
Results (January – June 2010)
Total number of births: 248
Post Partum Women
Number Vaccinated
Percent Vaccinated
208 83.9%
Results (January – June 2010)
Total number of births: 248
Primary Caregivers
Number Vaccinated
Percent Vaccinated
42 16.9%
Post Partum Women
Number Vaccinated
Percent Vaccinated
208 83.9%
Results (January – June 2010)
Total number of births: 248
Primary Caregivers
Number Vaccinated
Percent Vaccinated
42 16.9%
Post Partum Women
Number Vaccinated
Percent Vaccinated
208 83.9%
Time for a Change
• Postpartum vaccination on target• Primary caregiver vaccination rate lower than
expected• Barriers identified:– Fear of Needles– Time– Lost voucher
Local Health Department Differences
County 1 County 2
Appointment Needed? No Yes
Administration Fee Charged? No Yes
Local health department resources used
Healthy start nurses
Packets sent to new parents
Proximity to hospital Across the street Across the street
Caregiver Immunization Rates, January – June 27.9% 14.3%
Local Health Department Differences
County 1 County 2
Appointment Needed? No Yes
Administration Fee Charged? No Yes
Local health department resources used
Healthy start nurses
Packets sent to new parents
Proximity to hospital Across the street Across the street
Caregiver Immunization Rates, January – June 27.9% 14.3%
Process Enhancements
• Standing order for family member vaccination prior to mother and infant discharge
• Involve stake holders– Medical Records, Nursing staff, Pharmacists,
Pediatricians, OB/GYN, Local Health Departments
Stumbling Blocks
• Admission to the hospital versus no admission for designated family member– Liability concerns– Tracking methods– Cost
• Hospital conglomerates
Ransom Memorial
Feb-10
Mar-10
Apr-10
May-10
Jun-10Jul-1
0
Aug-10
Sep-10
Oct-10
Nov-10
Dec-10
Jan-11
Feb-11
Mar-11
0%
20%
40%
60%
80%
100%
Perc
ent o
f Car
egiv
ers V
acci
nate
d (B
ased
on
num
ber o
f birt
hs)
Began vaccinating caregiver at hospital
Lessons Learned
• The best laid plans• There’s more than one way to skin a cat• Get them while they’re hot• Don’t throw the baby out with the bath water• It takes a village
Current Activities
• Local health departments offered Tdap to vaccinate new parents
• Tdap offered to hospitals to vaccinate mom and caregiver
Needed Actions
• Continued education of hospitals and OB/Gyns about importance of vaccinating – New recommendations by ACIP
• Educate new moms on pertussis– Brochures, etc.
• Work with hospitals to overcome barriers to vaccinating caregivers
Acknowledgements• KDHE Staff
– Martha Siemsen, ARNP-BC– Sue Bowden, RN, BS– Immunization Staff
• 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
Elizabeth Lawlor, MSEpidemiologist
Bureau of Epidemiology and Public Health InformaticsKansas Department of Health and Environment
785-368-8208 [email protected]