Women’s Health Care and Education Coalition Post Partum Tdap Initiative Program Christine Armenti, RN, BSN,MS NJDHSS Hepatitis B Coordinator Vaccine Preventable Disease Program NJ Dept. of Health and Senior Services

Post Partum Tdap Initiative In 2006, ACIP recommended routine administration of Tdap for postpartum women not previously vaccinated to provide protection and reduce the risk for transmitting Pertussis to their infants. In 2007, the New Jersey Vaccine Preventable Program launched an initiative to vaccinate new mothers with Tdap vaccine. 2008 MMWR statement for the prevention of Tdap. Program Initiatives included developing mission statement and goals.

Mission Statement GOALS: Prevent and/or reduce the risk of Pertussis transmission from mother to her infant child. GOALS: Develop a Tdap postpartum multidisciplinary advisory group Promote awareness and provide education to the medical community of the ACIP Postpartum Tdap recommendations Obtain buy-in from the medical community (i.e., birthing hospital’s Ob-Gyn Medical Directors, Women’s Ambulatory Care Centers and Federally Qualified Health Center’s Ob-Gyn to vaccinate new mothers) Promote awareness and provide education materials to pregnant and non-pregnant women of childbearing age of the Tdap vaccine recommendation

Advisory Group Spring 2008 Established Goals and Objectives Reviewed New Jersey Pertussis rates Reviewed New Jersey health care infrastructure Reviewed New Jersey birth rates Discussed anticipated barriers for recruiting hospitals Reviewed the current FQHCs adult vaccine initiative

New Jersey Population Rates Population: 8.7 million (2006 U.S. Census) Ethnicity: Highly diverse and foreign born population Birth rate: Slightly less in New Jersey than the United States as a whole: 14.0 births per 1,000 or 114, 000 births per year Median age of mother at birth: 30.5 55% of women are 25 to 34 years of age at pregnancy 14. 4% Uninsured 6. 8% Medicaid 67.1% Privately Insured Highest rate of uninsured: 38. 6% among age group 19 to 24 years old

Health Care Providers 57 New Jersey Birthing Hospitals 19 Federally Qualified Health Centers (FQHCs) and an additional 48 FQHC satellite sites Other Healthcare Sites: Hospital based Ambulatory Care Centers Planned Parenthoods Private Ob-Gyn Providers

New Jersey Pertussis Statistic's 2007 Pertussis Surveillance: 389 cases of Pertussis reported among women of reproductive age (15-44) 37 cases in infants < than 12 months of age New Jersey DTaP rate among children age 29 to 35 months that received four DTaP vaccine doses: 84.4% National rate: 85.1%

Advisory Group Several FQHCs were already established as adult vaccine sites through the NJVFC adult initiative, which provides vaccines to those Medicaid eligible or uninsured. NJ Adult Vaccine Sites: 1 Refugee Clinic 5 Migrant Farm Worker Clinics 6 Over Age 65 Clinics (Influenza/Pneumovax) STD Clinics All NJ FQHCs are users of the NJVFC Program, and aware of the NJVFC vaccine ordering and accountability process

Advisory Group Focus: Postpartum vaccination in hospitals Informal survey of 10 NJ hospitals Just starting to vaccinate Health Care Workers with Tdap Barriers and Concerns Providing adult vaccines was a public health issue Vaccine infrastructure is in the community Economics – cost – time Extra paperwork Tracking vaccine history Who will vaccinate other family members? Other vaccine recommendations? Dichotomy of care Privately insured patients vs. VFC patients

Focus Shifted NJVFC Coordinator Actively engaged the established NJVFC and FQHC sites Population is vaccine eligible Located in areas of the state with high birth rates Infrastructure in place for New Jersey Immunization Information System (NJIIS) NJVFC Participants Three FQHC sites agreed to pilot the Tdap Initiative Medical Directors very interested See the end result of sick children Two FQHC Sites To provide Tdap at the postpartum visit (6 weeks) Will provide Tdap vaccination to other eligible clients Will provide other recommended adult vaccines to clients One FQHC Site To provide Tdap at the 2 week newborn visit to mother Will provide vaccine to other extended eligible family members Father to baby, grandparents and other household members Will provide HPV, Influenza and Menactra as appropriate to eligible patients Electronic Medical Records

Current Tdap Initiative Status Need to focus on education and awareness for providers and the public Education is actively done by public health drug representatives for hospital OB-GYN medical directors NJ Hospital Association Providing hospitals with Tdap educational materials that is given to all prospective mothers during the pre-delivery hospital tour at 36 weeks Fall 2008 – 2 hospitals began process to implement a Tdap postpartum standing order policy Hospital to purchase vaccine

Tdap Status Three FQHC pilot sites offering Tdap Vaccine To date approximately 240 doses administered High incidence of no-show for postpartum visit Concerns related to NJVFC paperwork Concerns of reporting status of initiative to NJDHSS Use NJIIS Registry to document adult vaccination Vaccine refusal due to vaccine concerns Education is given to moms prior to delivery date Report that mothers who understand they can protect their babies from infection are most likely to accept the vaccine Language and cultural barriers OB-GYN providers refer pregnant women to the Primary Provider for Influenza vaccine

Looking Towards the Future Actively working with New Jersey Primary Care Association (Provides funds to FQHCs) to recruit more FQHCs for the initiative Continue to partner with NJ Hospital Association Education needed for all disciplines of medical providers NJVFC Conference in Fall 2009 Meet with 19 FQHC Medical Directors in Summer 2009 Other educational venues as available