Pertussis surges, but HCW vaccination lags
Nation on track for most cases since 1959
As the nation faces the largest outbreak of pertussis in 50 years, the rate of vaccination of health care workers languishes at about 20%.
By mid-July, 18,000 cases had been reported to the Centers for Disease Control and Prevention in Atlanta, with the largest outbreaks in Washington state and Wisconsin. Infants are especially at risk; so far this year, nine babies have died of pertussis.
Yet vaccination coverage with Tdap, the pertussis booster that also contains tetanus and diphtheria vaccine, has remained low among health care workers. Vaccination is most critical for health care workers who care for infants and pregnant women, but the CDC recommends Tdap vaccination “as soon as feasible” even for health care workers who recently received a tetanus booster.1
From 2005 to 2010, only 20.3% of health care workers received the vaccine, according to the National Health Interview Survey.
To boost vaccination, Washington state sent reminders to all licensed health care professionals. An awareness campaign, with billboards and ads on television, radio, buses and social media, is urging all adults to receive the pertussis vaccine. “We hope everyone is getting the message about the vaccination,” said Washington Secretary of Health Mary Selecky in a press briefing.
Overworked at epicenter
Skagit County was an epicenter of the epidemic, with the highest rate of pertussis in the country. Skagit Valley Hospital in Mount Vernon, WA, scrambled to verify the vaccination status of employees, especially those who said they had received the vaccine elsewhere.
At the beginning of the epidemic, only about a third of hospital employees had received Tdap. By mid-July, that number had jumped to 67%.
Employee health nurse Greta Ashley, RN, BSN, CIC, used peer vaccinators and other strategies from the annual influenza vaccination playbook. But the pertussis response has been overwhelming.
Even vaccinated employees who have an unprotected exposure to a patient with pertussis should have antimicrobial prophylaxis or be monitored daily for symptoms for 21 days, according to CDC guidelines. Employees who have had an exposure and develop symptoms should be furloughed for five days, CDC says.
Ashley had to put other employee health projects on hold and worked 50-hour weeks to keep up with the pertussis response. She is the only employee health nurse for 1,800 employees and 400 volunteers.
She did find a receptive audience in the employees. Even some who balk at the influenza vaccine have come to get their Tdap, she says. “There is a sincerity about trying to protect the infants,” she says.
Vaccine isn’t ‘perfect’
The Washington outbreak has highlighted some concerns about the durability of the pertussis vaccine. Cases have spiked among 13- and 14-year-olds, which might be a sign of waning immunity from childhood vaccines, says Anne Schuchat, MD, director of CDC’s National Center for Immunization and Respiratory Diseases.
CDC recommends booster shots for 11- and 12-year-olds. But a change in the vaccine may be another factor, says Schuchat. In 1997, in an effort to avoid some potential adverse effects, the United States switched from a whole cell vaccine to an acellular vaccine. The switch “might have done something to impact how long the vaccines last,” Schuchat said at a press briefing.
Meanwhile, the vaccine is only about 66% to 78% effective, which is why even vaccinated health care workers need prophylaxis after an exposure.1
For now, CDC recommends only a one-time booster for health care workers. But with further research, CDC is investigating the issue of waning immunity.
“Vaccines have done a good job at reducing the incidence of pertussis, but our pertussis vaccines are not perfect,” Schuchat said in the press briefing. “They don’t provide protection for as long as we wish they would. This adds to our challenges during these times of the increased disease. We wish we had better ways of controlling pertussis.
“But remember that without vaccines, we know we would have hundreds of thousands of pertussis cases each year,” she said.
Reference
1. Centers for Disease Control and Prevention. Immunization of Healthcare Personnel – Recommendations of the Advisory Committee on Immunization Practices. MMWR 2011; 60:1-45.
As the nation faces the largest outbreak of pertussis in 50 years, the rate of vaccination of health care workers languishes at about 20%.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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