Workshop - Immunization Policy and Programmatic Response to Increased Pertussis In California, 2010

Background:  In 2010 California had the highest incidence of pertussis reported in over half a century, including >7000 cases and 10 infant deaths. Barriers to widespread immunization against pertussis after early childhood have included

• Limited awareness about or access to immunization with Tdap
• Hesitation about Tdap immunization during pregnancy, beyond licensed age groups, at brief intervals after immunization with Td, and in other situations where national recommendations have been unclear.

Setting:  State of California

Population:  Immunizers; local health departments; general population

Project Description:  In response, California Department of Public Health (CDPH) has provided 1) Expanded recommendations since July 2010 that emphasize

• Tdap immunization for all persons >10 years of age not yet immunized, including those >64 years of age, regardless of timing of last Td booster, especially for: 
  • Women of childbearing age before, during or immediately after pregnancy
  • Other close contacts of infants
  • Health care workers
  • Patients >7 years of age in need of tetanus immunization for wounds.
• On-time immunization of young children with DTaP as early as 6 weeks of age. Children 7-9 years of age who did not receive all routine childhood DTaP doses should receive Tdap.

2) Information about reimbursement and liability coverage for Tdap immunization. 3) Publicly-purchased Tdap booster immunizations to hospitals, community health centers and tribal clinics to immunize close contacts of newborn infants. 4) Education about the timely diagnosis and treatment of pertussis, especially in infants.

Results/Lessons Learned:  CDPH’s materials were widely disseminated and utilized with the assistance of public and private partners. In October 2010 ACIP adopted similar expanded recommendations for immunization with Tdap. CDPH provided >200,000 doses of Tdap to birth hospitals and clinics and subsidized the administration of <90,000 additional doses by a community vaccinator at settings designated by local health departments.