Gynäkologie und Geburtshilfe

Gynäkologie und Geburtshilfe
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ISSN: 2161-0932


Michigan Birthing Hospital Approach to Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccine in an Obstetrical Population

Fariha Hussain, Cristi A Carlton, Courtnay R Londo, Patricia A Vranesich and Bernard Gonik

Objective: Pertussis infections have risen exponentially in the United States with the highest incidence of morbidities and mortalities in infants less than one year of age. Although Center for Disease Control and Prevention recommendations have recently changed several times, current recommendations are to give tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine during each pregnancy to all gravidas between 27 and 36 weeks gestation or immediately postpartum. Vaccine “cocooning” of close contacts is also advocated to reduce transmission to newborns. This study was undertaken to determine Michigan birthing hospitals’ Tdap vaccination policies and practices.

Methods: A telephone survey of Michigan birthing hospital administrators was conducted May-June 2012. Statistical analysis was by Fisher exact test for categorical variables.

Results: Response rate was 83% of Michigan’s 84 birthing hospitals. Fifty-one (73%) reported a process in place to assess gravida Tdap vaccine status. Only 14 (20%) had a written policy. Vaccine cost was the most cited barrier (21%) to policy implementation. The majority (91%) of hospitals surveyed indicated that they offered Tdap. The minority (11%) evaluated antepartum-admitted gravidas or vaccinated household contacts (4%). All hospitals documented vaccination in hospital records; only 53% entered these data into the Michigan Care Improvement Registry (MCIR). Most (77%) documented vaccination refusal; few (6%) recorded this in MCIR. Hospitals affiliated with other hospitals and hospitals affiliated with an Obstetrics/Gynecology residency program were more likely to have written postpartum Tdap vaccination policies (P=0.03).

Conclusions: Based on recall data, many Michigan birthing hospitals have not adequately addressed pertussis vaccine surveillance in an obstetrical patient population. Although most reported assessing postpartum patients for vaccine status, few had a written policy. Vaccine opportunities are being missed during the antepartum period and for other close contacts. Finally, suboptimal utilization of a robust statewide vaccine registry compromises the long-term care of these patients.