Preven&ng Pertussis: Current and Needed Strategies. June 16, PM 8PM

Transcription

1 Preven&ng Pertussis: Current and Needed Strategies June 16, PM 8PM

2 Acknowledgements

3 Agenda Welcome and Introduc&ons Epidemiology of Pertussis Essi M. Havor, MSN, APHN, RN Houston Health Department Preven&ng Pertussis: Current and Needed Strategies for Reducing Pertussis in Infants Michele Cur=s, MD, MPH Q&A Adjourn

4 Haleigh was too young to receive the vaccine. It would have saved her life. -Rodney Throgmorton Source: Vaccine- preventable Disease: The ForgoEen Story

5 Pertussis Trends in Houston, Texas Essi M. Havor MSN, APHN, RN Houston Health Department Immuniza=on Bureau

6 Pertussis Clinical Case Definition Cough lasting at least 2 weeks and with one of the following: Paroxysmal of coughing or, Inspiratory whoop or, Post-tussive vomiting If under 1 year old, apnea with or without cyanosis

7 Laboratory Criteria for Diagnosis Isolation of Bordetella Pertussis from a clinical specimen (culture) or Positive polymerase chain reaction (PCR) for B Pertussis* *Direct fluorescent antibody (DFA) staining of a patient s specimen and serological laboratory results (pertussis IgG or IgM) are NOT considered confirmatory for pertussis.

8 Epidemiological Trends

9 Figure A. Chart courtesy of CDC

10 Figure 1. * Graph provided via Texas DSHS

11 What Is Going On In Houston!!!???

12 Figure 3.

13 Figure 4.

14 Figure 5.

15 Figure 6.

16 Reportable by Law in Texas Healthcare Provider/Facilities responsibilities: Report confirmed & probable case to your local health department within one work day of diagnosis Laboratory responsibilities: Report positive lab reports immediately to healthcare provider Report positive lab reports within one work day of diagnosis to the local health department Outbreaks are to be reported immediately!

17 Conclusions The average number of pertussis cases significantly increased in 2013 which may be linked to the waning effectiveness of the pertussis vaccine after 3-4 years. The highest incidence of pertussis was observed in Hispanic Female infants under one year of age. The high rates within the Hispanic community may be due to a low level of immunization coverage in this group. Most reported cases are unvaccinated due to being under age making them more susceptible to infection. A Majority of cases in Houston occur between May and August, peaking in late June early July.

18 Reference Figure A : Figure 1:

19 Acknowledgements Houston Health Department, Bureau of Epidemiology, Staff, Provider, and Patients. Thomas Johnson, Public Health Investigator CDC Funding Angency

20 Preven&ng Pertussis: Current and Needed Strategies for Reducing Pertussis in Infants Presented by Michele Cur&s, MD, MPH June 2, 2016

21 The Pertussis Problem Infants <2 months have an annual incidence of pertussis of 160 per 100,000 1/2 of infants <1 year with pertussis are hospitalized Sources: CDC (2015). Pertussis (Whooping Cough). h]p:// Terranella, Andrew, et al. (2013). Pregnancy Dose Tdap and Postpartum Cocooning to Prevent Infant Pertussis: A Decision Analysis. Pediatrics 131:

22 The Pertussis Problem Disease Reproduc&ve Rate Pertussis % Measles % Mumps % Influenza >60% Ebola Herd Immunity Threshold Pertussis is roughly >6 &mes more contagious than Ebola Requires a high herd immunity threshold Sources: Michigan Center for Public Health Awareness, h]ps://prac&ce.sph.umich.edu/micphp/epicentral/basic_reproduc_rate.php Es&mates of the reproduc&on number for seasonal, pandemic, and zoono&c influenza: a systema&c review of the literature, h]p://bmcinfectdis.biomedcentral.com/ar&cles/ / Seasonal influenza in the United States, France, and Australia: transmission and prospects for control, h]p://

23 Current Strategies Early Childhood Vaccina&on Adolescent and Adult Vaccina&on Cocooning Maternal Vaccina&on

24 Current Strategies Early Childhood Vaccina&on Adolescent and Adult Vaccina&on Cocooning Maternal Vaccina&on Recommended Schedule, 2016 BENEFITS Effec&ve for 8 or 9 out of 10 children Among children who get all 5 doses of DTaP vaccine on schedule 98 out of 100 are fully protected within the year following the 5 th dose 7 out of 10 of children are fully protected 5 years aier gemng their last dose of DTaP vaccine and the other 3 are protected against serious disease. Source: Center for Disease Control and Preven&on, h]p:// effec&veness.html

25 Current Strategies Early Childhood Vaccina&on Adolescent and Adult Vaccina&on Cocooning Maternal Vaccina&on Recommended Schedule, 2016 Sources: Center for Disease Control and Preven&on, Na&onal Immuniza&on Survey, 2014 Healthy People 2020, h]ps:// objec&ves/topic/ immuniza&on- and- infec&ous- diseases/objec&ves

26 Current Strategies Early Childhood Vaccina&on Adolescent and Adult Vaccina&on Cocooning Maternal Vaccina&on CHALLENGES First dose isn t un&l 2 months Immunity wanes over &me Mul&ple doses mean more opportuni&es to fall behind, as is demonstrated by the difference in rates between 3 doses and 4 at the state level Some evidence showing it doesn t prevent transmission, only disease Sources: Pertussis vaccine performance in an epidemic year Oregon, 2012, h]p://cid.oxfordjournals.org/content/early/2014/04/18/cid.ciu273.abstract Acellular pertussis vaccines protect against disease but fail to prevent infec&on and transmission in a nonhuman primate model, h]p://

27 Current Strategies Early Childhood Vaccina&on Adolescent and Adult Vaccina&on Cocooning Maternal Vaccina&on BENEFITS Provides a booster to protect and con&nue immunity Given at the same &me as other adolescent vaccines Doubles as a tetanus booster In general, protects 7 out of 10 people who receive it Protects younger family members Source: Center for Disease Control and Preven&on, h]p:// effec&veness.html,

28 **Recommenda&on: 1 dose at age 11-12**

29 **Recommenda&on: 1 dose during adulthood**

30 Current Strategies Early Childhood Vaccina&on Adolescent and Adult Vaccina&on Cocooning Maternal Vaccina&on Sources: Center for Disease Control and Preven&on, Na&onal Immuniza&on Survey, 2014 Healthy People 2020, h]ps:// objec&ves/topic/ immuniza&on- and- infec&ous- diseases/objec&ves

31 Disease Outbreaks and Exemp&ons 2013 Non- Medical Exemp<on Hot Spots 2013 Pertussis Hot Spots Source: Graphics and table from the Texas Department of State Health Services presenta=on, Immuniza=on Coverage in Texas: Child and Adolescent Vaccine Coverage. Can be accessed at: hlps:// TISWG111214_CoverageLevels.pdf

32 Current Strategies Early Childhood Vaccina&on Adolescent and Adult Vaccina&on Cocooning Maternal Vaccina&on CHALLENGES Booster dose may come too late, as immunity from childhood vaccina&on begins to wain around ages 7-10 years Many adults don t know about the recommenda&on Protec&on fades over &me. Only 3 or 4 out of 10 people are fully protected 4 years auer gemng Tdap Sources: Center for Disease Control and Preven&on, h]p:// effec&veness.html Pertussis vaccine performance in an epidemic year Oregon, 2012, h]p://cid.oxfordjournals.org/content/early/2014/04/18/cid.ciu273.abstract

33 Current Strategies Early Childhood Vaccina&on Adolescent and Adult Vaccina&on Cocooning Maternal Vaccina&on

34 Current Strategies Early Childhood Vaccina&on Adolescent and Adult Vaccina&on Cocooning Maternal Vaccina&on BENEFITS Because a young infant is most likely to get pertussis from someone close to them, vaccina&ng all close contacts at least 2 weeks prior to mee&ng the baby helps to limit opportuni&es for exposure Source: Center for Disease Control and Preven&on, h]p://

35 Current Strategies Early Childhood Vaccina&on Adolescent and Adult Vaccina&on Cocooning Maternal Vaccina&on Sources: Vaccina&on Coverage Among Adults, Excluding Influenza Vaccina&on United States, 2013, h]p:// Surveillance of Vaccina&on Coverage Among Adult Popula&ons United States, 2014, h]p://

36 Current Strategies Early Childhood Vaccina&on Adolescent and Adult Vaccina&on Cocooning Maternal Vaccina&on CHALLENGES Not effec&ve on its own Access challenges for low- income adults, including many childcare workers Sources: Center for Disease Control and Preven&on, h]p:// Evalua&on of the impact of a pertussis cocooning program on infant pertussis infec&on, h]p://

37 Current Strategies Early Childhood Vaccina&on Adolescent and Adult Vaccina&on Cocooning Maternal Vaccina&on BENEFITS Most effec&ve strategy for preven&ng pertussis in infants <8 weeks old Safety profile has been well established Source: Center for Disease Control and Preven&on, h]p://

38 **Recommenda&on: 1 dose during every pregnancy at weeks' gesta&on regardless of interval since prior Td or Tdap vaccina&on.**

39 Strong Provider Recommenda&on is Cri&cal to Vaccine Uptake Presump&ve recommenda&on vs permissive recommenda&on Presump=ve: I d like to give you the Tdap vaccine today to protect your baby from pertussis. Do you have any ques=ons? Permissive: Would you like the Tdap vaccine today?

40 Strong Provider Recommenda&on is Cri&cal to Vaccine Uptake Offering the vaccine is not the same as recommending it. Recommending: I want you and your baby to be protected against pertussis. I think it s really important that you receive the vaccine today. Offering: If you d like, we can vaccinate you against pertussis today.

41 Strong Provider Recommenda&on is Cri&cal to Vaccine Uptake Same day: Recommend AND administer Tdap vaccine during the same visit, if possible

42 Responding to Hesitancy Using the CASE Method Corroborate Acknowledge the parents concern and find some point on which you can agree. Set the tone for a respec[ul, successful talk. About Me Describe what you have done to build your knowledge base and exper=se. Science Describe what the science says. Explain/Advise Give your advice, based on the science. Source: Au&sm Science Founda&on

43 Current Strategies Early Childhood Vaccina&on Adolescent and Adult Vaccina&on Cocooning Maternal Vaccina&on CHALLENGES Not all prenatal care providers stock vaccines at their site

44 Needed Strategies Increase educa&on/outreach among key popula&ons Increase Collabora&ons with Pharmacists Enact Policies that Encourage Uptake and Increase Access Improve Vaccine Effec&veness

45 Increase educa&on/outreach among key popula&ons Providers Pregnant Women Adults with infants under 1 year Childcare Workers Pharmacists

46 Increase Collabora&ons with Pharmacists Pharmacists can provide addi&onal immuniza&on services for pa&ents whose healthcare providers do not stock vaccines Communica&on between pharmacists and other health care providers is cri&cal to ensure con&nuity of care

47 Enact Policies that Encourage Uptake and Increase Access Change Immuniza&on Registry from Opt- in to Opt- out Tightening exemp&ons around school vaccine requirements Consider modifying vaccina&on schedule to incorporate booster dose(s) earlier and/or more ouen

48 Enact Policies that Encourage Uptake and Increase Access Expand access through Adult Safety Net Program Allow commercial pharmacies and other convenient loca&ons to par&cipate Broaden criteria so that more low- income adults can par&cipate Revisit childcare worker vaccina&on policy law to more strongly encourage Tdap requirements for infant caretakers

49 Improve Vaccine Effec&veness In addi&on to maintaining a strong safety profile, a new vaccine is needed that: Has longer immunity Prevents transmission as well as disease Can be given in fewer doses Some have suggested a return to former vaccine, DTP, for the first dose or for the en&re series

50 Thank you!