Tdap Cocooning Project: An Innovative Strategy for Vaccine Delivery

Background:  2010 saw a pertussis epidemic in California.  To date, there have been 6431 cases of pertussis, with a state rate of 16.4 cases/100,000.  75% of hospitalized cases were infants < 6 months of age.  Ten deaths have been reported, all in infants < 2 months of age.  90% of fatalities were in Hispanic infants. CDPH offered free Tdap to birthing hospitals to immunize postpartum women and their families (cocooning strategy). 

Setting: Postpartum floor + Outpatient Pharmacies

Population: Pregnant and postpartum women; family members (ages 7 and up)

Project Description:  2 vaccine clinics established   1)  Postpartum floor.  Free Tdap vaccine (provided by CDPH) offered to any visiting family member.  (All postpartum women who lacked written documentation of prior Tdap also received vaccine prior to discharge.)  2) Vaccine clinic at outpatient pharmacies.  Free Tdap vaccine offered on a walk-in basis during set hours each afternoon.  In both models, vaccines were delivered by pharmacy students, supervised by licensed pharmacists.

Results/Lessons Learned: Offering free vaccine to visiting family members on the inpatient, postpartum floor was a programmatic success.  Over a three-month period, 1600 postpartum women, family members, and friends received Tdap vaccine.  48% of recipients were Hispanic.  Outpatient pharmacies were less successful. Less than two dozen Tdap vaccines were given over the same period of time.  Lessons learned:  1) family members are highly motivated to receive vaccine when they understand the cocooning concept; 2) taking the vaccine clinic directly to family members (postpartum floor) will lead to more successful vaccination rates than having family members make their way to outpatient pharmacies; 3) multi-disciplinary approach will add to success of program (pharmacy department); 4) 'town crier' -- M.D. or pharmacist walked the hallways to answer questions most evenings, floor nurses very involved and spoke with each visiting family.  5) Standing orders for every postpartum patient also key to succeess.