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

2. 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

3. 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

7. 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)

8. 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:
(the 2010 update was reformatted, but is not different than the 1997 definition)

9. 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)

10. 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

11. 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!

12. 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

13. 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

14. 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

15. 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

16. 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:
To order directly from GSK:

17. Vaccine Eligibility for LHDs

18. 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

19. 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

20. 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
Will post updated list on Coordinator web site tomorrow

21. 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

22. 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

23. I&E Pertussis Materials
Continuing to develop new materials
Developing PSAs
Outreach with partner organizations
All pertussis materials can be found at:

24. 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?