1. 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

2. 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.

3. 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

4. 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

5. 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

6. 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

7. 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: %
National rate: %

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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