Antepartum Cocooning with Tdap Vaccine to Prevent Pertussis and Promote Maternal, Fetal and Neonatal Outcomes

Background: It is well documented that pertussis has been on the rise worldwide for the past 20 years, with the highest morbidity and mortality in infants less than 12 months of age.  California had a pertussis epidemic in 2010 with the death of 10 infants less than 3 months of age.  Today pertussis rates remain high in California and in other states.  With the most current ACIP recommendations to immunize pregnant women, not previously immunized with Tdap, after 20 weeks gestation, there is a great opportunity for providers of obstetrical care to better protect pregnant women, the fetus and the neonate through Antepartum administration of Tdap vaccine.

Setting: Twenty-eight private providers of obstetrical care offered no-cost Tdap after 20 weeks gestation to pregnant women and their spouse/significant other. These providers included Obstetricians, Family Practice physicians and Certified Nurse Midwives.

Population: These providers serve pregnant women of all racial, ethnic, economic backgrounds and community sizes across the state of Nevada.

Project Description: The Nevada State Health Division, Immunization Program, offered no-cost Tdap vaccine to providers of obstetrical care across the state.  Most were previous providers of H1N1 and/or influenza vaccine for pregnancy. Evidence-based research and ACIP recommendations were presented to the providers.  We wanted to see the learning curve for providers and pregnant women with this new cocooning strategy.  We also wanted so see how many pregnant women and family members we could immunize with Tdap over the first 6-12 months of the project.

Results/Lessons Learned: Some providers of obstetrical care were more eager to follow ACIP recommendations than others.  With continuing education and encouragement these providers have been gradually increasing the rate of Antepartum Tdap immunizations in Nevada.  We have even had more providers of obstetrical care requesting to participate in this project.  Final numbers will be available October 2013.