Background: Pertussis

Transcription

1 MITIGATING PERTUSSIS: WHAT PERINATAL SERVICE COORDINATORS CAN DO Figure 1 Figure 1: Pictures of San Diego family who lost baby to pertussis. Retrieved August 18 th, 2016 from: Rebeca Boyte, MAS Health Educator Supervisor CDPH, Immunization Branch DRAFT: FOR DISCUSSION PURPOSES ONLY Background: Pertussis Pertussis (whooping cough) is highly contagious respiratory disease. Known for uncontrollable, violent coughing Deep breaths after coughing fits often result in a "whooping" sound. Infants at highest risk for hospitalization & death. Symptoms in infants include: Gagging Vomiting Gasping Apnea Seizures 1

2 Pertussis is cyclical w is the time to act BEFORE the next epidemic peak *Infants may not have the typical presentation ACOG, AAFP, and ACIP Recommendations Tdap during each pregnancy Optimal timing: weeks. Postpartum Tdap & cocooning do not provide direct antibody protection to baby Tdap in the 3 rd trimester = Standard of Care Reported Receipt of Tdap Vaccination During Pregnancy, Maternal Infant Health Assessment (California), by Race/Ethnicity, 2014 (Ca) 2

3 Pertussis Use Case Team Goal: To systematically collect data to inform California Department of Public Health and other partners to make policy and programmatic changes that will support prenatal care providers in providing vaccines to pregnant women; local health departments (LHD) to undertake small tests of change at the provider level Among Medi-Cal members, 2014: ~250,000 pregnant women ~345 pertussis cases, 3 deaths (< 4 mos. of age) Infant Pertussis Surveillance Efforts 1. Identify and begin to address vaccination barriers for > 20 infants reported with pertussis since Jan Create a prioritized list of state level policy, finance, and program changes and implement the highest priority state-level policy changes Shape the Path : Approach to Prioritizing Recommendations Inconsistent Tdap Recommend Worst /Weak Yes Strong Best Strong Referral Stock Tdap /Weak Strong Tdap Tdap Strong Recommendation: Strongly encourages woman to get Tdap between weeks gestation, emphasizing protection for baby. Strong Referral: Strongly encourages woman to get Tdap off-site, ensures off-site location can vaccinate woman, and follows up. DRAFT: FOR DISCUSSION PURPOSES ONLY 3

4 Preliminary Findings From January through October 2016, 76 pertussis cases <4 months of age were reported to CDPH. Of those reported, 39 (51%) mothers and providers completed the supplemental interview 16/39 (41%) received Tdap during pregnancy 15/16 (94%) were vaccinated during their routine OB visit 13/16 (81%) were vaccinated <36 weeks gestation 8/39 (21%) received Tdap at the hospital at/after delivery 15/39 (38%) did not receive Tdap at any time 8/15 (53%) unvaccinated mothers were offered Tdap but refused for various reasons. One death was reported among the 39 cases interviewed; the mother was vaccinated at 39 weeks, outside of the recommended timeframe. Preliminary Findings Cont. Stocking Tdap is essential: there is a significant association between the receipt of Tdap during pregnancy and having Tdap stocked onsite (p-value=<.0001). Among providers who stock (n=15), many are not following best practices nor providing strong recommendations: 2 women were vaccinated after recommended timeframe 1 woman was not recommended to receive the vaccine 4 women refused vaccination Inadequate reimbursement (9/15) and cost (4/15) of vaccine are the most commonly cited reason for not stocking Tdap by those who don t currently offer it Preliminary Findings Cont. Current referral practices are not working: ne of the mothers who were referred to get Tdap off-site received Tdap (n=8). women were vaccinated at a pharmacy WIC could be a venue to remind women to get vaccinated: 18/39 women participated in WIC; of these only 33% received Tdap. CPSP plays an important role: 21/39 (54%) providers reported participating in CPSP; 11 (52%) of these stock Tdap. 4

5 CPSP Providers of Moms with Babies Who Developed Pertussis 20% Stocked & Recommended Tdap but Tdap receipt inconsistent with guidelines/mother refusal 10% 20% 15% 0% Did not stock Tdap Recommendation unknown referral Worst Did not stock Tdap /weak recommendation referral Did not stock Tdap Tdap recommend But no/weak referral Did not stock Tdap but Strong recommendation & Strong referral 5% 30% Best Best Practices: Stocked Tdap Strong Recommendation Stocked Tdap But no recommendation DRAFT: FOR DISCUSSION PURPOSES ONLY Medi-Cal Provider Bulletins: Jul and Jan Prenatal Care: Medi-Cal Focuses on Tdap for Pregnant Women Effective for dates of service on or after August 1, 2014, Medi-Cal policy for CPT-4 code (tetanus, diphtheria toxoids and acellular pertussis vaccine [Tdap], when administered to individuals 7 years or older, for intramuscular use) is aligned with the most recent recommendations from the Advisory Committee on Immunization Practices (ACIP). The new portion of the policy follows: Providers of prenatal care must implement a Tdap immunization program for all pregnant women. Health care personnel should administer a dose of Tdap during each pregnancy, irrespective of the patient s prior history of receiving Tdap. To maximize the maternal antibody response and passive antibody transfer to the infant, optimal timing for Tdap administration is between 27 and 36 weeks gestation, although Tdap may be given at any time during pregnancy. Routinize the offer wks. Uphold same standard of care Tdap in stock Educate all staff Document Make a strong recommendation 5

6 Make a strong recommendation and referral Assist patients in finding local immunization provider Ensure patients ability to travel off-site Provide patients with prescription Follow-up at subsequent appointments Strongly consider stocking Tdap Tdap not in stock Document California Regulations (Title 16, Section ) Require pharmacists to: 1. Report immunizations into the immunization registry and inform the patient about record-sharing preferences; 2. Maintain the vaccine record at the pharmacy and provide a copy to the patient; and 3. tify a patient s primary care provider (PCP) of immunizations administered within 14 days. For pregnant women, the pharmacist should notify the prenatal care provider. Patients without a PCP should be advised to consult a health care provider. Medi-Cal Policy Medi-Cal Fee for Service (FFS) and Medi-Cal Managed Care Plans (MCPs) cover Tdap vaccine between weeks gestation of every pregnancy and are required to have the ACIP-recommended adult immunizations (including Tdap) as part of their pharmacy formulary benefit. 6

7 Administrative Review Tool Scope of Work CDPH Materials for Prenatal Care IMM-887 IMM-1146 IMM-1145* IMM

8 Questions? (510)