Tdap Booster Research Articles

Immunisation schedule of the Spanish Association of Paediatrics: 2016 recommendations

The Advisory Committee on Vaccines of the Spanish Association of Paediatrics (CAV-AEP) annually publishes the immunisation schedule which, in our opinion, estimates optimal for children resident in Spain, considering available evidence on current vaccines. We acknowledge the effort of the Ministry of Health during the last year in order to optimize the funded unified Spanish vaccination schedule, with the recent inclusion of pneumococcal and varicella vaccination in early infancy. Regarding the funded vaccines included in the official unified immunization schedule, taking into account available data, CAV-AEP recommends 2+1 strategy (2, 4 and 12 months) with hexavalent (DTPa-IPV-Hib-HB) vaccines and 13-valent pneumococcal conjugate vaccine. Administration of Tdap and poliomyelitis booster dose at the age of 6 is recommended, as well as Tdap vaccine for adolescents and pregnant women, between 27-36 weeks gestation. The two-dose scheme should be used for MMR (12 months and 2-4 years) and varicella (15 months and 2-4 years). Coverage of human papillomavirus vaccination in girls aged 11-12 with a two dose scheme (0, 6 months) should be improved. Information for male adolescents about potential beneficial effects of this immunisation should be provided as well. Regarding recommended unfunded immunisations, CAV-AEP recommends the administration of meningococcal B vaccine, due to the current availability in Spanish communitary pharmacies, with a 3+1 scheme (3, 5, 7 and 13-15 months). CAV-AEP requests the incorporation of this vaccine in the funded unified schedule. Vaccination against rotavirus is recommended in all infants. Annual influenza immunisation and vaccination against hepatitis A are indicated in population groups considered at risk.

Calendario de vacunaciones de la Asociación Española de Pediatría (CAV-AEP): recomendaciones 2016

The Advisory Committee on Vaccines of the Spanish Association of Paediatrics (CAV-AEP) annually publishes the immunisation schedule which, in our opinion, estimates optimal for children resident in Spain, considering available evidence on current vaccines. We acknowledge the effort of the Ministry of Health during the last year in order to optimize the funded unified Spanish vaccination schedule, with the recent inclusion of pneumococcal and varicella vaccination in early infancy.Regarding the funded vaccines included in the official unified immunization schedule, taking into account available data, CAV-AEP recommends 2+1 strategy (2, 4 and 12 months) with hexavalent (DTPa-IPV-Hib-HB) vaccines and 13-valent pneumococcal conjugate vaccine.Administration of Tdap and poliomyelitis booster dose at the age of 6 is recommended, as well as Tdap vaccine for adolescents and pregnant women, between 27-36 weeks gestation.The two-dose scheme should be used for MMR (12 months and 2-4 years) and varicella (15 months and 2-4 years).Coverage of human papillomavirus vaccination in girls aged 11-12 with a two dose scheme (0, 6 months) should be improved. Information for male adolescents about potential beneficial effects of this immunisation should be provided as well.Regarding recommended unfunded immunisations, CAV-AEP recommends the administration of meningococcal B vaccine, due to the current availability in Spanish communitary pharmacies, with a 3+1 scheme (3, 5, 7 and 13-15 months). CAV-AEP requests the incorporation of this vaccine in the funded unified schedule. Vaccination against rotavirus is recommended in all infants.Annual influenza immunisation and vaccination against hepatitis A are indicated in population groups considered at risk.

A Systems Approach to Improving Tdap Immunization Within 5 Community-Based Family Practice Settings: Working Differently (and Better) by Transforming the Structure and Process of Care.

We examined how family medicine clinic physicians and staff worked in collaborative teams to implement an automated clinical reminder to improve tetanus, diphtheria, and acellular pertussis (Tdap) booster vaccine administration and documentation. A clinical reminder was developed at 5 University of Michigan family medicine clinics to identify patients 11 to 64 years old who were in need of the Tdap booster vaccine. Quality improvement cycles were used to improve clinic care processes. Immunization rates from 2008 to 2011 were compared with rates at 4 primary care control clinics. Vaccination rates among eligible patients increased from 15.5% to 47.3% within the family medicine clinics and from 14.1% to 30.2% within the control clinics. After adjustment for covariates, family medicine patients had a higher probability of vaccination than control patients during each measurement period (0.17 vs 0.15 at baseline, 0.53 vs 0.22 during year 1, and 0.50 vs 0.30 during year 2). Automated clinical reminders, when designed and implemented via a consensus-based framework that addresses the process of care, can dramatically improve provision of preventive health care.

Effects of interpersonal communication, knowledge, and attitudes on pertussis vaccination in Vermont

The United States is currently experiencing its worst pertussis outbreak in 50 years. Although pertussis is easily preventable through vaccination, many people are unaware of the severity of the disease and the need for adult booster vaccinations. This study surveyed 629 people using a statewide telephone survey to examine vaccination rates, factors affecting vaccination decisions, and the role of communication with healthcare providers, family, and friends in vaccine decision making. Findings indicate that most participants had not been vaccinated for pertussis in the last 5 years. Furthermore, there are disparate pertussis diagnoses and vaccination rates among adults. The main contribution of this study is the examination of sources of influence on adults’ decisions to receive the Tdap booster. The primary source of influence and vaccine recommendation was healthcare providers. We also found that successful vaccination recommendations were most frequently justified by claims that the booster would protect the participant's personal health, rather than community health or infant health. When discussing the adult Tdap booster with eligible patients, healthcare providers should focus information and recommendations on patients’ health, rather than include messages about benefits to community health or the health of infants they may come in contact with.

Adolescent immunization: 2015 and beyond.

In the last decade, the approach to adolescent immunizations has changed substantially. At ages 11 or 12 years, routine administration of four vaccines-a tetanus, diphtheria, pertussis (Tdap) booster, the first of two doses of quadrivalent conjugate meningococcal vaccine (MCV4), a three-dose series of human papillomavirus (HPV) vaccine, and an annual influenza vaccine-are now recommended. Vaccine uptake is easily tracked in the office setting using electronic medical records, whereas national data for teens have been tracked through the National Immunization Survey-Teen (NIS-teen) since 2005. In 2013, NIS-teen demonstrated that Tdap and MCV4 uptake are robust, whereas HPV vaccine coverage lags behind substantially. Efforts to improve immunization coverage rates among adolescents should continue, especially as new vaccines are becoming available for use in this age group. Several changes in the current approach to teen vaccination are expected to emerge in 2015.

Immunisation schedule of the Spanish Association of Paediatrics: 2015 Recommendations

The Advisory Committee on Vaccines of the Spanish Association of Paediatrics updates the immunisation schedule every year, taking into account epidemiological data as well as evidence on the safety, effectiveness and efficiency of current vaccines, including levels of recommendation. In our opinion, this is the optimal vaccination calendar for all children resident in Spain. Regarding the vaccines included in the official unified immunization schedule, the Committee emphasizes the administration of the first dose of hepatitis B either at birth or at 2 months of life; the recommendation of the first dose of MMR and varicella vaccine at the age of 12 months, with the second dose at the age of 2-3 years; DTaP or Tdap vaccine at the age of 6 years, followed by another Tdap booster dose at 11-12 years old; Tdap strategies for pregnant women and household contacts of the newborn, and immunization against human papillomavirus in girls aged 11-12 years old with a 2 dose scheme (0, 6 months). The Committee reasserts its recommendation to include vaccination against pneumococcal disease in the routine immunisation schedule, the same as it is being conducted in Western European countries. The recently authorised meningococcal B vaccine, currently blocked in Spain, exhibits the profile of a universal vaccine. The Committe insists on the need of having the vaccine available in communitary pharmacies. It has also proposed the free availability of varicella vaccines. Their efectiveness and safety have been confirmed when they are administred from the second year of life. Vaccination against rotavirus is recommended in all infants. The Committee stresses the need to vaccinate population groups considered at risk against influenza and hepatitis A.

Preliminary study on the immunogenicity of a newly developed GCC Tdap vaccine and its protection efficacy against Bordetella pertussis in a murine intranasal challenge model.

Purpose Active reduced dose tetanus-diphtheria-acellular pertussis (Tdap) vaccination for adolescents and adults is necessary because waning immunity after primary diphtheria-tetanus-pertussis vaccination is related to the recent emergence of pertussis. This study was conducted to compare the immunogenicity and protection efficacy against Bordetella pertussis between a new GCC Tdap vaccine and a commercially available Tdap vaccine in a murine model.Materials and MethodsBALB/c mice were immunized with two doses of diphtheria-tetanus-acellular pertussis (DTaP) vaccine for priming and a subsequent Tdap booster vaccination. According to the type of booster vaccine, mice were divided into four groups: commercially available Tdap vaccine in group 1 and GCC Tdap vaccines of different combinations of pertussis antigens in groups 2 to 4. Humoral and cell-mediated immune responses and protection efficacy using a murine intranasal challenge model after booster vaccination were compared among the four groups.ResultsEvery group showed significant increases in antibody titers against pertussis antigens such as pertussis toxin, filamentous hemagglutinin, and pertactin after booster vaccination. Spleen cells showed both Th1 and Th2 cell-mediated immune responses stimulated by pertussis antigens in all groups without any significant difference. In the intranasal B. pertussis infection model, bacteria were eradicated in all groups five days after challenge infection.ConclusionThis preliminary study did not show significantly different immunogenicity or protection efficacy of the new GCC Tdap vaccines compared to the commercially available Tdap vaccine, although a more extensive study is necessary to assess the differing efficacies of the new GCC Tdap vaccines.

Tdap: the need to educate and immunize.

The resurgence of pertussis is puzzling, especially given the requirement that children complete recommended immunizations prior to school entry. Are adult carriers unknowingly infecting children? What do adult caregivers know about pertussis and the tetanus, diphtheria, and acellular pertussis (Tdap) booster vaccine? How can the incidence of pertussis in children younger than 2 years, a group most at risk for complications of the disease, be reduced? This article examines the incidence of pertussis and strategies to reduce pertussis incidence in the United States. If the need for Tdap vaccine is identified and favorably received by adults, immunization programs can be arranged at worksites to better protect infants who are most at risk for pertussis.

Low seroprevalance of diphtheria, tetanus and pertussis in ambulatory adult patients: the need for lifelong vaccination

BackgroundTetanus, diphtheria, pertussis and measles are vaccine preventable diseases that have been reported to cause morbidity and mortality in adult population in the recent years. We aimed to document the seropositivity rates and vaccination indication for these four vaccine preventable diseases among adult and elderly patients who were seen as outpatients in a university hospital. MethodsBlood samples for tetanus, diphtheria, pertussis and measles antibodies were obtained. Results were evaluated with regards to protection levels and booster vaccine indications according to the cut-off values. ResultsA total of 1367 patients consented for the study and 1303 blood samples were available for analysis at the end of the study. The antibody levels against measles conferred protection in 98% of patients. However, 65% of the patients had no protection for diphtheria, 69% had no protection for tetanus and 90% of the patients had no protection for pertussis. Only 1.3% of the study population had seropositivity against three of the diseases—Tdap booster was indicated in 98.7%. Multivariable logistic regression showed that tetanus protection decreased with increasing age. Having a chronic disease was associated with a lower rate of protective antibodies for pertussis. ConclusionsWe demonstrated very low rates of protection against three of the vaccine preventable diseases of childhood—diphtheria, pertussis and tetanus. Booster vaccinations are required in adult life in accordance with national and international adult vaccination guidelines. The concept of “lifelong vaccination” should be implemented and every encounter with the patient should be regarded as a chance for catch-up.

Cost-effectiveness of Tdap vaccination of adults aged ≥65 years in the prevention of pertussis in the US: a dynamic model of disease transmission.

ObjectivesIn February 2012, the Advisory Committee on Immunization Practices (ACIP) advised that all adults aged ≥65 years receive a single dose of reduced-antigen-content tetanus, diphtheria, and acellular pertussis (Tdap), expanding on a 2010 recommendation for adults >65 that was limited to those with close contact with infants. We evaluated clinical and economic outcomes of adding Tdap booster of adults aged ≥65 to “baseline” practice [full-strength DTaP administered from 2 months to 4–6 years, and one dose of Tdap at 11–64 years replacing decennial Td booster], using a dynamic model.MethodsWe constructed a population-level disease transmission model to evaluate the cost-effectiveness of supplementing baseline practice by vaccinating 10% of eligible adults aged ≥65 with Tdap replacing the decennial Td booster. US population effects, including indirect benefits accrued by unvaccinated persons, were estimated during a 1-year period after disease incidence reached a new steady state, with consequences of deaths and long-term pertussis sequelae projected over remaining lifetimes. Model outputs include: cases by severity, encephalopathy, deaths, costs (of vaccination and pertussis care) and quality-adjusted life-years (QALYs) associated with each strategy. Results in terms of incremental cost/QALY gained are presented from payer and societal perspectives. Sensitivity analyses vary key parameters within plausible ranges.ResultsFor the US population, the intervention is expected to prevent >97,000 cases (>4,000 severe and >5,000 among infants) of pertussis annually at steady state. Additional vaccination costs are $4.7 million. Net cost savings, including vaccination costs, are $47.7 million (societal perspective) and $44.8 million (payer perspective). From both perspectives, the intervention strategy is dominant (less costly, and more effective by >3,000 QALYs) versus baseline. Results are robust to sensitivity analyses and alternative scenarios.ConclusionsImmunization of eligible adults aged ≥65, consistent with the current ACIP recommendation, is cost saving from both payer and societal perspectives.

658Assessment of Knowledge, Awareness, and Attitudes Towards Pertussis and Pertussis Immunization Strategies in Post-Partum Mothers

Background: Given increases in the incidence of pertussis, protective strategies for young infants are used (cocooning, maternal immunization), but there is limited data regarding two key areas for implementation knowledge of pertussis in pregnant women, and their willingness to participate in various preventative campaigns. With increasing rates of pertussis in Manitoba and anticipating future public health needs should Manitoba move toward a maternal immunization strategy, we surveyed post-partum women on their knowledge and beliefs of infant pertussis and prevention strategies. Methods: Women were interviewed at the two obstetrical centers in Winnipeg. A survey was developed using the Health Belief Model, assessing knowledge level about pertussis, beliefs and attitudes towards pertussis immunizations, and willingness to participate in two protective strategies (thirdtrimester or mother only post-partum immunization). There was then an educational portion about pertussis and follow-up questions to determine whether this had changed their views. Results: Of 143 women surveyed over 8 months, 67% had a moderate knowledge score regarding pertussis and its risks; 55% of participants considered Tdap (tetanus-diphtheria-acellular pertussis) to be safe. Only 5% of women reported having discussed pertussis with their physician during their pregnancy. Fifty-seven percent of participants would have agreed to receive Tdap immediately post-partum, and 65% would consider Tdap in the third trimester of a subsequent pregnancy. There was a significant link between pertussis knowledge levels and intent to vaccinate (p Results Conclusions References Table 1: Demographic characteristics of interviewed women (n = 143) Had received Tdap booster 2% yes 92% no 5% unsure Source of prenatal care 2% did not receive prenatal care 22% received prenatal care from a Family Doctor 66% received prenatal care from an OBGYN specialist 9% received prenatal care from a Nurse Practitioner 1% received prenatal care from a Midwife Did the prenatal care provider talk about pertussis? 2% talked about pertussis without being asked by the patient 3% talked about pertussis after being asked by the patient 92% did not talk about pertussis with the patient 3% of patients were not sure or could not recall

Pregnancy Dose Tdap and Postpartum Cocooning to Prevent Infant Pertussis: A Decision Analysis

Infants <2 months of age are at highest risk of pertussis morbidity and mortality. Until recently, the US Advisory Committee on Immunization Practices (ACIP) recommended protecting young infants by "cocooning" or vaccination of postpartum mothers and other close contacts with tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis, adsorbed (Tdap) booster vaccine. ACIP recommends pregnancy vaccination as a preferred and safe alternative to postpartum vaccination. The ACIP cocooning recommendation has not changed. We used a cohort model reflecting US 2009 births and the diphtheria-tetanus-acellular pertussis schedule to simulate a decision and cost-effectiveness analysis of Tdap vaccination during pregnancy compared with postpartum vaccination with or without vaccination of other close contacts (ie, cocooning). We analyzed infant pertussis cases, hospitalizations, and deaths, as well as direct disease, indirect, and public health costs for infants in the first year of life. All costs were updated to 2011 US dollars. Pregnancy vaccination could reduce annual infant pertussis incidence by more than postpartum vaccination, reducing cases by 33% versus 20%, hospitalizations by 38% versus 19%, and deaths by 49% versus 16%. Additional cocooning doses in a father and 1 grandparent could avert an additional 16% of cases but at higher cost. The cost per quality-adjusted life-year saved for pregnancy vaccination was substantially less than postpartum vaccination ($414 523 vs $1 172 825). Tdap vaccination during pregnancy could avert more infant cases and deaths at lower cost than postpartum vaccination, even when postpartum vaccination is combined with additional cocooning doses. Pregnancy dose vaccination is the preferred alternative to postpartum vaccination for preventing infant pertussis.

Modelling pertussis transmission to evaluate the effectiveness of an adolescent booster in Argentina

Due to the current epidemiological situation of pertussis, several countries have implemented vaccination strategies that include a booster dose for adolescents. Since there is still no evidence showing that the adolescent booster has a positive effect on the most vulnerable group represented by infants, it is difficult to universalize the recommendation to include such reinforcement. In this work we present an age-structured compartmental deterministic model that considers the outstanding epidemiological features of the disease in order to assess the impact of the booster dose at age 11 years (Tdap booster) to infants. To this end, we performed different parameterizations of the model that represent distinct possible epidemiological scenarios. The results obtained show that the inclusion of a single Tdap dose at age 11 years significantly reduces the incidence of the disease within this age group, but has a very low impact on the risk group (0-1 year). An effort to improve the coverage of the first dose would have a much greater impact on infants. These results hold in the 18 scenarios considered, which demonstrates the robustness of these conclusions.

Adult Immunization 2012: Politics, Process, and Progress

In this issue, the ACIP presents the recommended Adult Immunization Schedule for 2012. The editorialist discusses the rationale behind key changes between this and previous ACIP recommendations.

Reduced-Antigen, Combined Diphtheria, Tetanus and Acellular Pertussis Vaccine, Adsorbed (Boostrix®)

Reduced-antigen, combined diphtheria, tetanus and three-component acellular pertussis vaccine (Tdap; Boostrix®) is indicated for booster vaccination against diphtheria, tetanus and pertussis in individuals from age four years onwards in Europe and from age 10 years onwards in the US. Compared with infant formulations used for primary vaccination, Tdap contains reduced quantities (10-50%) of all toxoids and antigens, which are adsorbed to either ≤0.39 mg/dose (US licensed formulation) or 0.5 mg/dose (rest-of-world formulation) of aluminium adjuvant. The reduced antigen content is designed to avoid the increasing reactogenicity historically seen with the fourth and fifth doses of infant vaccine. This article reviews the immunogenicity, protective efficacy and reactogenicity of Tdap booster administered to children, adolescents and adults, including those aged ≥65 years. In clinical trials, a single booster dose of Tdap induced seroprotective levels of antibodies to diphtheria and tetanus toxoids in virtually all children and adolescents, and in a high proportion of adults and elderly individuals at approximately 1 month post-vaccination irrespective of their vaccination history. In all age groups, seropositivity rates for antibodies against pertussis antigens were ≥90% (including in unvaccinated adolescents), and booster response rates were high. Tdap was safely co-administered with other common vaccines without significantly affecting the immune responses. The immunogenicity and reactogenicity profiles of booster doses of Tdap were generally similar to those of infant diphtheria-tetanus-whole-cell pertussis vaccine and infant diphtheria-tetanus-acellular pertussis vaccine in children aged 4-6 years, and infant diphtheria-tetanus vaccine in older children. In adolescents and adults, the immunogenicity and reactogenicity of Tdap were generally similar to those of reduced-antigen diphtheria-tetanus vaccine, reduced-antigen diphtheria-tetanus-five-component acellular pertussis vaccine and reduced-antigen acellular pertussis vaccine. Therefore, Tdap is suitable as a booster in place of these vaccines, including tetanus toxoid vaccine in the management of tetanus-prone wounds in adults. The quantity of aluminium adjuvant in Tdap did not markedly affect the immunogenicity or reactogenicity of the vaccine. Seropositivity rates for antibodies against pertussis toxin had begun to decline by 5 years after a booster dose of Tdap in adolescents/adults, and a subsequent booster dose 10 years later was generally as immunogenic as the initial booster and was well tolerated. Tdap was safe and well tolerated in all age groups. Local injection-site reactions were the most common adverse events. Most adverse events were of mild or moderate intensity and transient; there were few serious vaccination-related adverse events. Thus, Tdap is highly immunogenic, with low reactogenicity, in all age groups and appears suitable for targeted and/or repeat Tdap boosters in children, adolescents, adults and elderly individuals as part of immunization strategies that may prove beneficial in further limiting the burden of pertussis.

Immunization 2011: Expanding Coverage, Enhancing Protection

Annually, the ACIP of the Centers for Disease Control and Prevention issues a revised Adult Immunization Schedule that is approved by the major specialty societies representing physicians who care ...

Withdrawal of Infant Cold Medicines Decreases ED Visits by Half, CDC Finds

apart (Beytou J et al. Hum Vaccin. 2009; 5[5]:315-321; Halperin SA et al. Pediatr Infect Dis J. 2006;25[3]:195-200). Additionally, because there is no vaccine approved for individuals older than 64 years, grandparents and health professionals in this age group are at high risk of becoming infected or spreading it to vulnerable individuals. But the data indicate vaccinating these individuals with Tdap is safe, Baker said. In fact, one of the 2 makers of Tdap have submitted an application to the FDA to allow marketing of the vaccine for use in these older adults. “Giving them the vaccine looks very safe,” Baker said. She noted that the most common adverse effect with Tdap vaccination has been sore arm. Children between the ages of 7 and 10 years have also posed a challenge to clinicians. Sometimes children in this age group do not have records that indicate whether they have received their final DTaP vaccination; in these cases, the CDPH and the ACIP recommend that clinicians give the child their Tdap booster early to ensure they are protected. Again, although this use is not approved by the FDA, the literature and the experience of other countries suggest such use is safe. For example, Brady noted that in Canada, Tdap is used to vaccinate children aged 4 years or older and appears safe. “From a pediatrician’s perspective, we frequently have to catch up undervaccinated children,” he said. “This [recommendation] is very consistent with other approaches we take [to bring children up-to-date on immunizations].” However,Bakernoted thatprivate insurancemaynotcoverandMedicarewill not cover such off-label use of the Tdap vaccine. In California, Schechter said that it is not yet clear if 2010 represents the peak of the current epidemic. There have been fewer reported cases in some regions of the state, particularly in places like Fresno, where an uptick in cases was reported early. But the number of cases reported remains high in other areas, such as San Diego County, where the 10th fatality was recently reported. Schechter urged physicians to stay on guard against pertussis and work to maintain high vaccination rates because fatalities have occurred even in years with fewer cases. “We want to avoid complacency,” he said. “[Pertussis] can be a nasty disease at any age, but a fatal disease for young infants.”

Evaluation of an Intervention Program to Increase Immunization Compliance Among School Children

State immunization laws necessitate compliance for students enrolling in a public or private school system. In support of state laws, school nurses expend hours to achieve immunization compliance with school-age children. For the purpose of creating a more efficient system, researchers implemented an educational and incentive program in local elementary schools to increase tetanus, diphtheria, and acellular pertussis (Tdap) booster compliance rates. Students were instructed in regard to their immune systems, immunizations, and where to obtain immunizations. In addition, compliant students were entered into a drawing for an iPod Shuffle or a RipStick. In 2009, the compliance rate expanded from 4% to 57% during a 4-week intervention program. Notably, the Tdap immunization compliance rate in the previous year (2008) was 54%. Researchers concluded that the intervention did not improve compliance rates significantly.

Effectiveness of Adolescent and Adult Tetanus, Reduced‐Dose Diphtheria, and Acellular Pertussis Vaccine against Pertussis

Pertussis is among the most poorly controlled bacterial vaccine-preventable diseases in the United States. In 2006, a tetanus, reduced-dose diphtheria, and acellular pertussis (Tdap) booster was recommended for adolescents and adults. Tdap vaccines were licensed on the basis of antibody response without vaccine effectiveness data. From 30 September 2007 through 19 December 2007, a pertussis outbreak occurred at a nursery through twelfth grade school on St. Croix, US Virgin Islands. We screened all students for cough and collected clinical history, including Tdap receipt. Coughing students were offered diagnostic testing. We defined clinical case patients as students with cough 14 days in duration plus either whoop, paroxysms, or post-tussive vomiting, and we defined confirmed case patients as students with any cough with isolation of Bordetella pertussis or those with clinical cases and polymerase chain reaction or serological evidence of pertussis; other clinical cases were classified as probable. There were 51 confirmed or probable cases among 499 students (attack rate, 10%). Disease clustered in grades 6-12, with a peak attack rate of 38% among 10th graders. Of 266 students aged 11 years with complete data, 31 (12%) had received Tdap. Forty-one unvaccinated students (18%) had confirmed or probable pertussis, compared with 2 (6%) of the vaccinated students (relative risk, 2.9); vaccine effectiveness was 65.6% (95% confidence interval, -35.8% to 91.3%; P = .092). This first evaluation of Tdap vaccine effectiveness in the outbreak setting suggests that Tdap provides protection against pertussis. Increased coverage is needed to realize the full benefit of the vaccine program. Serological testing was an important tool for case identification and should be considered for inclusion in the Council of State and Territorial Epidemiologists case definition.

Pertussis and Patient Safety: Implementing Tdap Vaccine Recommendations in Hospitals

Despite the availability of pediatric vaccines against pertussis ("whooping cough"), the disease is poorly controlled. Adolescents and adults with waning immunity, especially immediate family members, are responsible for 76%-83% of pertussis transmission to infants. Adolescent/adult tetanus, diphtheria, and acellular pertussis (Tdap) booster vaccines were licensed in the United States in 2005, but their use has been low and hospitals' implementation of immunization recommendations suboptimal. Efforts were implemented at two hospitals in Chicago to increase postpartum use of Tdap vaccine and to replace the tetanus and diphtheria toxoids (Td) booster with Tdap vaccine in emergency department (ED) settings. Postpartum Pertussis Vaccination Program at Prentice Women's Hospital: In the program's first 18 months (June 2008-November 2009) 9,540 doses of Tdap vaccine were administered to 78.87% of the postpartum patients. Children's Memorial Hospital: Tdap Use in Emergency Settings: In 2007, uptake of Tdap was slow. During 2008, of 43 ED patients receiving a tetanus toxoid-containing vaccine as part of wound management, 10 were given Tdap (20 had previously received a dose of Tdap vaccine). Hospital-based Tdap initiatives in postpartum and ED settings can be successfully implemented, provided that support is obtained not only from key decision makers at the hospital but also the health care providers who will be directly involved in implementing those initiatives. It is imperative that hospitals implement programs that increase the use of Tdap vaccine among postpartum women, in emergency settings, and among health care personnel.