1. Our Vision – Healthy Kansans living in safe and sustainable environments. www.kdheks.gov

2. Cocooning Newborns Against Pertussis Martha Siemsen, APRN-BC Medical Investigator Bureau of Epidemiology and Public Health Informatics Kansas Department of Health and Environment 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) Post Partum Women Number Vaccinated Percent Vaccinated Percent Protected* 43582.5%84.3% Primary Caregivers Number Vaccinated Percent Vaccinated 9718.4% 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. Our Vision – Healthy Kansans living in safe and sustainable environments. 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