1. Kathie Lloyd MSN, RN, CNM, CNS NSHD, IZ Special Projects Manager Faculty, UNR College of Nursing Northern Nevada Immunization Coalition California Immunization Pertussis Task Force Every Child By Two Pertussis Task Force

2.  List at least two IZ special projects that are helping prevent pertussis in Nevada  Name the one hospital in Nevada that has “cocooned” newborns against pertussis and influenza for almost five years  Describe why influenza vaccine is being added to “cocooning” programs in many Nevada birthing hospitals and in many OB/GYN provider offices  Explain why might OB/GYN HCPs be an excellent vaccine home for many women

3.  #2 – Tdap for Healthcare Workers  #3 – Tdap for “Cocooning” Birthing Hospitals  #4 – Tdap for Tribes  #5 – Tdap in Our Communities and Schools

4.  January 2011 ACIP re-recommendations  February 2011 TJC recommendations  19/19 Nevada hospitals doing births provided Tdap to their HCWs  13/15 Nevada hospitals with an Emergency Room provided Tdap to their HCWs  Total of 32/34 Nevada hospitals provided Tdap to their HCWs  Total of 1,791 doses of Tdap given to HCWs in 2010 with vaccine available for new hires....

5.  Who are Nevada’s pioneers?  Renown Regional Medical Center  Carson Tahoe Regional Medical Center  St. Mary’s Regional Medical Center  University Regional Medical Center

6.  First full-scope hospital to “cocoon” in the U.S.  Began educating and offering Tdap vaccine to staff June 2006  Began educating and offering Tdap vaccine to parents of newborns July 2006  Began educating and offering influenza vaccine to parents of newborns October 2006  Currently working on improving inputting immunizations into Nevada WebIZ  Caught the attention of the CDC….

7. YearDeliveriesDoses of Tdap 2006 4,903 2,986 2007 4,781 5,540 2008 4,275 5,551 2009 4,114 4,559 2010 3,559 4,643 2011 540 779 TOTAL22,172 24,058

8. YearDeliveries Doses of Flu 2006 4,903 690 2007 4,7811,481 2008 4,275 1,957 2009 4,114 1,636 2010 3,559 1,858 2011 540 265 TOTAL22,172 7,887

9. YearDeliveriesDoses of Tdap 2007 1,035 150 2008 999 806 2009 922 735 2010 855 728 2011 115 140 TOTAL 3,9262,559

10. YearDeliveriesDoses of Tdap 2008 2,302 1,100 2009 2,175 1,313 2010 2,152 3,433 2011 424 297 TOTAL 7,053 6,143

11. YearDeliveries Doses of Tdap 2009 4,267 225 2010 3,770 2,270 2011 602 210 TOTAL 8,639 2,605

12. January 1, 2010 - March 14, 2011: Total Deliveries = 26,780 Total Doses of Tdap = 6,489 Some of these hospital have only been “cocooning” for a few months!

13.  There are 19 birthing hospitals in NV:  ALL of them are currently “cocooning”!  Nevada will be the FIRST state in the United States to have all of its birthing hospitals “cocooning” against pertussis!  Nevada will be FIRST in something GOOD for all the citizens of Nevada! !!

14. Tribe: Doses: Tribal - Yerington Paiute Tribal HC 4 Tribal - Washoe Tribal HC 30 Tribal - LV Paiute Tribe HHS 4 Tribal - Newe Medical Clinic 8 Tribal - Duckwater Shoshone HC 0 IHS - Pyramid Lake Public HN 22 Tribal - Moapa Paiute HHS 2 IHS - Nevada Urban Indians 1

15. Tribe:Doses: IHS - McDermitt HIS Clinic 1 Tribal – Owyhee Community Health 6 Tribal – Reno Sparks Tribal Health 47 Tribal - Walker River Tribal Health 23 IHS - Southern Bands HC - Elko Services 21 Tribal - Pyramid Lake Tribal Health 26 Tribal – Fallon Tribal Health Clinic 41 Total of 236 doses given thus far….

16.  Tdap sent to HCPs in communities that had reported cases of pertussis  Ely – 6 doses  Elko – 232 doses  Three school districts in Nevada received Tdap as part of a pilot program to bring vaccines back into our schools  Washoe County School District – 1,479 doses  Carson City School District – 550 doses  Elko County School District – 13 doses

18.  California Department of Public Health:  9,477 cases of pertussis in 2010; 514 in 2011  10 deaths of infants < 3 months of age  9 of these were infants < 2 months of age  Nevada State Health Division:  38 cases of pertussis in 2010; 7 in 2011  No deaths from pertussis

19.  Could it be our PROACTIVE APPROACH TO PERTUSSIS PREVENTION BEGINNING IN 2006 AND STILL GROWING?  Even with a 37M to 3M population difference, we should have seen more cases of pertussis in NV….  >46,167 doses of Tdap given so far…

20. Nevada is striving to achieve MONUMENTAL vaccine coverage with Tdap!!!

21.  Why this particular project?  Letter of invitation with requirements for obstetrical providers  30 OB sites in our pilot program  Data from our current sites  Plans for the future:  Writing a grant for $900,000 from the CDC  Hope to expand IZ Project #1 in 2011-2012

22.  Northern NV – 6 sites with 319 doses  Rural Nevada – 5 sites with 147doses  Southern Nevada – 19 sites with 860 doses 1,326 doses thus far and still immunizing….

23.  Governor’s Council for Developmental Disabilities (PACE)  480 doses of influenza vaccine given  Consulate of Mexico to Nevada (COM)  471 doses of influenza vaccine given and still immunizing….  Community Clinics  184 doses of influenza vaccine given

24.  All of these are non-traditional ways to “cocoon” newborns and “high-risk” adolescents and adults against influenza  36,000 deaths each year from influenza  Underserved populations often are at greater risk from influenza  >2,461 doses of influenza vaccine so far….

25.  To continue our ongoing immunization programs against pertussis and influenza!  To create and implement additional programs to protect all populations in Nevada against pertussis, influenza and other vaccine preventable diseases!  To continue making MONUMENTAL efforts to make Nevada a safe and healthy place to live!!!

26. Kathie Lloyd MSN, RN, CNM, CNS NSHD, IZ Special Projects Manager klloyd@health.nv.gov 775-684-3477 Amanda (Mandy) Harris Nevada WebIZ Manager asharris@health.nv.gov 775-684-4258