1. Linda K. Ohri, PharmD, MPH, Natalie Van Heek, PharmD Candidate, Ted Kasha, BS Jkjkj

2. Objectives Share Survey Results: Describe Pertussis outbreak in an academic health care provider (HCP) population Compare characteristics of clinical vs confirmed cases Identify potential patient and infant exposure from confirmed vs clinical cases vs other possibly exposed groups Present Pertussis immunization rates for various subgroups Discuss implications of survey findings for Pertussis control © © 2003 Pedro Gomes, URL:webpages.fc.ul.pt/~mcgomes/ vacinacao/pnv/index3.htm

3. Background Fall 2007: New mandate initiated for CU health sciences students to obtain Tdap 2007 - Sept 24: “Five cases of whooping cough have been confirmed among Creighton University pharmacy students. ” Omaha World Herald Fall 2008: Online Survey of all SPAHP students, faculty and staff

4. Methodology Survey conducted using Campus supported Online Survey System (Blue Q by Vovici) Survey instrument reviewed and pre-tested Demographics Questions re any symptoms, and medical contact History of Pertussis vaccination Narrative comments about outbreak management and on perceptions of Pertussis disease and vaccination. Three reminder notices, at 1 week intervals in Sept/Oct of 2008.

5. Demographics Percent Response Rate N = 499

6. Case Definitions: Clinical Case: “A cough illness lasting at least 2 weeks with one of the following: paroxysms of coughing, inspiratory “whoop,” or posttussive vomiting; and without other apparent cause (as reported by a healthcare professional).” In outbreak settings: “a clinical case can be defined as an acute cough illness lasting 2 weeks or longer without other symptoms.” “demonstrated 84% sensitivity and 63% specificity for detecting culture-positive pertussis in outbreak settings.” www.cdc.gov/vaccines/pubs/surv-manual/chpt10- pertussis.htm#6

7. Results - Case Review:

8. Pertussis Sx  Respondent Groups  TotalThree Symp- toms # / % Two Symp- toms # / % One Symp- tom # / % No Symp- toms # / % Classic Whoop # / % Clinical Cases * 266 (23%) 11 (43%)3 (12%)10 (38%) Clinical Cases from focal class 83 (38%) 1 (25%) 5 (62%) Positive Diagnosis (5 in focal class) 64 (67%)2 (33%)005 (83%) * Clinical cases = persistent cough + seen by HCP

9. Results Patient Contact  Respondent Groups  TotalPatient Contact Infant in Household Infant Contact: At least weekly / Some Contact All49974%7%22% / 77% Clinical Cases2669%12%31% / 83% Positive Pertussis Diagnosis 667%0%17% / 83% Patient Contact: Campus Students - 87 % ; Faculty - 68 %

10. Percent Receiving Treatment / Prophylaxis Results

11. “adults who have not previously received Tdap can be vaccinated in accordance with the ACIP guidelines for Tdap use in outbreaks and settings of increased risk.” www.cdc.gov/vaccines/pubs/surv-manual/ chpt10-pertussis.htm#6

12. Results Overall, 35% did not answer vaccination Q - This graph assumes these respondents were not vaccinated

13. Implications Outbreak occurring in an Academic Setting : Many of these health sciences student and professionals have patient contact; some also have infant contact Care providers seeing exposed individuals may not report possible/probable clinical cases, and may not consider the individual’s likelihood of patient contact Exposed individuals often focus on antimicrobial prophylaxis or treatment, but do NOT consider immunization Patients and providers may have unrealistic beliefs about ongoing protection conferred by antimicrobial prophylaxis.

14. Implications Managing outbreaks in health sciences academic settings: Communicate facts/risks to the potentially exposed groups Warn exposed groups to be proactive To protect patients and infants To seek evaluation immediately if symptoms occur Clearly communicate clinical criteria for reporting cases – To exposed groups AND to local health care providers Clearly communicate role and limits of antimicrobial prophylaxis/treatment, - As well as benefits of immunization for future protection

15. Summary Pertussis outbreaks at academic medical centers have special risks Clinical cases may never be confirmed, and represent potential for spread to vulnerable populations Myths and misunderstandings may hinder optimal response to outbreaks, by patients and care providers Outbreaks represent an opportunity to promote Tdap administration, regardless of evidence for immediate benefit Pertussis vaccination mandates should be considered for both students and educators with patient contact

16. First Duty of a HCP: Do NO Harm Courtesy of: PA chapter of the AAP