CDPH, Immunization Branch Pertussis Update 7/6/2010 CDPH, Immunization Branch

AGENDA Pertussis Update: John Talarico/Kathleen Winter Tdap Vaccine Ordering/Supply: Claudia Aguiluz Tdap Vaccine Eligibility/Tdap Expansion Program: Maria Volk Pertussis Campaigns/Materials: Tiffany Sutter Activities Being Done by LHDs: Open Discussion

California Pertussis Cases - 2010 As of 6/30/2010, 1,337 pertussis cases and 5 infant deaths have been reported in 2010 A 5-fold increase from the number of reported cases during the same time period in 2009 An additional 700 cases are under investigation From January through June of 2005 there were 1,261 pertussis cases Data suggest the disease burden is at or above the levels seen in 2005, which was a 45 year high in cases

California Pertussis Deaths Five deaths in 2010 to date; age at symptom onset ranged from 5 days – 8 weeks 0 deaths were reported at this time last year All CA pertussis deaths (~3/year) since 1996, except one, have been in infants <3 months of age; 80% Hispanic (50% of birth cohort Hispanic)

CSTE Clinical Case Definition (same) Cough illness lasting >2 weeks with at least one of the following: Paroxysms Inspiratory ‘whoop’ Post-tussive vomiting Without other apparent cause (as reported by a health professional) Link to CSTE pertussis case definition: http://www.cdc.gov/ncphi/disss/nndss/casedef/pertussis_current.htm (the 2010 update was reformatted, but is not different than the 1997 definition)

CDPH Confirmed Case (new) Meets any of the following: Acute cough illness of any duration that is confirmed by culture for B. pertussis Acute cough illness of any duration with detection of B. pertussis antigen in formalin-fixed tissue by immunohistochemistry (IHC) methods (new) Meets the clinical case definition and is confirmed by PCR Meets the clinical case definition and is epi-linked directly to a lab-confirmed case (culture, PCR or IHC)

CDPH Probable Case (same) A case that meets the clinical case definition and is not laboratory-confirmed with culture, PCR or IHC and is not epi-linked directly to a confirmed case

Suspect Case (new) Meets either of the following: An acute cough illness of any duration with PCR confirmation. An acute cough illness of any duration with at least one of the following: (paroxysms of coughing, inspiratory "whoop", or post-tussive vomiting) that is epidemiologically-linked directly to a confirmed case. Please report all Confirmed, Probable and Suspect cases to CDPH!

May be used in lieu of a Case Report Form (CDPH 8258) for reporting contacts that are epi-linked to confirmed pertussis cases Please also report via vCMR/AVSS

Ordering Tdap for LHDs In order to assure adequate supply and fast processing of orders, please keep the following in mind: Given the current situation, CDPH is prioritizing LHD and hospital Tdap orders Take a look at your current inventory of Tdap and place an increased order to ensure sufficient doses on hand. Consider that Back to School is around the corner also! Place your order as quickly as possible if you are planning a special Tdap clinic or will be expanding clinic hours to accommodate public demand Submit Tdap orders in the normal VFC Vaccine Order Form - although not routinely encouraged, given the current situation you may submit supplemental orders for Tdap outside of your clinic’s Order Frequency

Processing Timelines Normal Orders: 10-15 business days Urgent Orders: 3-4 business days. Please indicate on your cover sheet and notify your Field Representative if you need an urgent order Immediate Vaccine Need: If you have ordered vaccine for a clinic and demand is larger than anticipated, please notify your Field Rep as soon as possible. We will attempt to locate additional vaccine for you-as best we can

Pertussis Containing Vaccines Manufacturer Vaccine Brand Name GSK DTaP Infanrix DTaP, Hep B, IPV Pediarix Tdap Boostrix DTaP/IPV Kinrix Sanofi Tripedia, Daptacel DTaP/IPV/HIB Pentacel Adacel

Vaccine Supply There are no shortages of any pertussis-containing vaccines. Individual distributors may be experiencing temporary back-orders due to increased demand. To order directly from sanofi: www.vaccineshoppe.com To order directly from GSK: https://www.gskvaccinesdirect.com/gsk/en/US/adirect/gsk

Vaccine Eligibility for LHDs

Vaccine Administration Fees Medi-Cal, CHDP fee: $9.00 All state provided vaccine: $17.55/dose maximum Equivalent to VFC regional maximum fee Caveat: Vaccine administration must not be denied due to inability to pay

Tdap Expansion Program Open to birth hospitals and hospitals with NICUs Vaccine available for post-partum moms and infant contacts. Hospitals can still apply just to immunize post-partum women if they are unable to do infant contacts Not available for staff Can order Tdap for hospital outpatient clinics to give to infant contacts No age/insurance limitations

Tdap Expansion Program 90 applications received Around 15,000 doses requested. Continuing to schedule hospital visits for non-VFC providers Providing updates to hospitals by email Will post updated list on Coordinator web site tomorrow

Tdap Expansion Program-Expanding Program will be opening up to all Community Health Centers and Indian Health Clinics CHCs and Indian Health Clinics will need to complete the enrollment paperwork and order vaccine on the Tdap Order Form Vaccine is only for post-partum moms and infant contacts

Program Eligibility Summary Type of Organization Eligibility for Vaccine LHDs All children and adults CHCs All children and postpartum moms and infant contacts Birthing hospitals-VFC Postpartum moms and infant contacts and eligible VFC children Birthing hospitals-non-VFC Postpartum moms and infant contacts Outpatient clinics associated with a birthing hospital Private providers VFC eligible children Indian health centers

I&E Pertussis Materials Continuing to develop new materials Developing PSAs Outreach with partner organizations All pertussis materials can be found at: http://www.cdph.ca.gov/HealthInfo/discond/Pages/Pertussis.aspx http://www.eziz.org/resources/materials_pertussis.html

Activities Being Done By LHDs Contacting hospitals to encourage them to participate in Tdap Program Conducting mass vaccination clinics when feasible. Conducting clinics in non-traditional settings Revision of LHD policies-offer Tdap at all opportunities Issuing press releases Conducting media campaigns Tdap and Flu Clinics Others?