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pertussis (option 2)

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Stephanie Cox

on 31 July 2013

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Transcript of pertussis (option 2)

Jackie Allen
Stephanie Cox
Mary Ismert
Jordan Taylor

Public Health Issue: Pertussis
Introduction
Socioeconomic Factors
Changing the Context
Clinical Interventions
How We Treat Pertussis
Long-Lasting Protective
Interventions
Counseling and Education

"Whooping cough"
Bordetella pertussis
These bacteria attach to the cilia (tiny, hair-like extensions) that line part of the upper respiratory system
Bacteria release toxins, which damage the cilia and cause inflammation (swelling)
The socioeconomic factors associated with pertussis rates relate almost singularly to vaccinations.

Education about Vaccines
Access to Vaccines
The population must be educated through media presentation, legislation and community supported programs to increase immunization access.
Immunizations for children and those in contact with children
DTaP-Children < 7 y.o.
Tdap-Booster for adolescent and adults
Both protect against pertussis, diptheria, and tetanus
Current treatment for pertussis is a macrolid antibiotic
Preferred treatment is 5 days Azithromycin
This is the only treatment for children under 1 month
7 day course of clarithromycin or 17 days of erythromycin are also used
Alternate therapy: trimethoprim-sulfamethoxazole (TMP-SMZ) for 14 days
Many parents and grandparents are not aware that their newborn/infant is at risk for pertussis
Do not know how transmitted
Do not know that vaccines need to be updated
Higher SES measures of household income, education level of mother, and marital status are associated with better health and better access to health care
No racial predisposition were found, but culture and ethnicity should be considered!
Public Service Annoucements
Information...
Legislation
Vaccinations requirements are a state to state decision; however, most state decisions reflect the recommendations put forth by The Advisory Committee on Immunization Practices (ACIP)

43 of the 50 States in the US have vaccination requirements at the secondary schooling level.

All 50 states have medical exemption laws, 48 of the 50 states have religious exemption laws, and 20 states have philisophical exemption laws
Vaccines for Everyone!
Vaccine Funding
Why do we care?

It is spread via infected droplets from coughing or sneezing
Symptoms begin to develop 7–10 days after exposure, but sometimes not for as long as 6 weeks
Most identified sources were from the household, of which 39% were mothers, 16% were fathers, and 5% were grandparents
Who is at risk?
Infants who are too young to be immunized and those who have not been immunized
Why is this an issue?
Pertussis vaccines are very effective in protecting you from the disease but no vaccine is 100% effective.
Health Impact Pyramid
Federal funds pay for approximately 95 percent of all publicly funded vaccinations. Two federal sources:
Vaccines for Children (VFC)
Section 317 of the Public Health Services Act
State Programs
Universal Purchase
Insurance Requirements
18,719 reported cases (2011)
Can last for up to 10 weeks or more; sometimes known as the "100 day cough."
More than half of infants less than 1 year of age who get pertussis are hospitalized.
Implications for Children
Children receive five doses
2, 4, 6, 15-18 months
4-6 years
Children age 7-10 receive Tdap if not fully immunized against pertussis
Implications for Adolescents and Adults
Should receive a single dose of Tdap especially if in close contact with infants i.e., day care workers, health care workers, siblings, and grandparents

A booster should be given every 10 years
Implications for Pregnant Women
Should receive a Tdap during each pregnancy
Preferably pre-pregnancy
If not before pregnancy, then at 27-36 weeks
If not during pregnancy, then prior to postpartum discharge
For Infants Too Young to Vaccinate
Cocooning - vaccinating people around the infant (parents, grandparents, etc). - “Herd Immunity”

In a study by Carrico & O'Keefe they looked at the cocooning strategy in practice.

The problem:
Only 50% of women in study were asked about Tdap status during postpartum stay
Of the 50% not asked, according to immunization records, 80% were eligible to receive Tdap vaccine
Only 14% of visiting family members were given information about Tdap to protect the newborn from pertussis
The Facts...
7. Tam, P. I., Visintainer, P., & Fisher, D. (2009). Response to an Education Program for Parents about Adult Pertussis Vaccination. Infection Control and Hospital Epidemiology, 30(6), 589-592.

8. "Tetanus, Diphtheria, (Pertussis) Mandates for Secondary Schools." Immunization Action Coalition (IAC): Vaccine Information for Health Care Professionals. N.p., Nov. 2012. Web. 25 Feb. 2013. <http://http://www.immunize.org/laws/tdap.pdf>.

9. Tiwari, T., Murphy, T. V., & Moran, J. (2005). Antimicrobial Agents for the Treatment and Postexposure Prophylaxis of Pertussis. Centers for Disease Control and Prevention: Morbidity and Mortality Weekly Report, 54(14), 1-13.

10. Wendelboe AM, Njamkepo E, Bourillon A, et al. Transmission of Bordetella pertussis to young infants. Pediatr Infect Dis J. 2007;26:293-99.

11. Winter, K., Harriman, K., Zipprich, J., Schechter, R.,Talarico, J., Watt, J., & Chavez, G. (2012). California Pertussis Epidemic, 2010. The Journal of Pediatrics, 161 (6), 1091-1096

12. Wooten, K. G., Luman, E. T., & Barker, L. E. (2007). Socioeconomic Factors and Persistent Racial Disparities in Childhood Vaccination. American Journal of Health Behavior, 31(4), 434-445.
References
1. Bisgard KM, Pascual FB, Ehresmann KR, et al. Infant pertussis: who was the source? Pediatr Infect Dis J. 2004;23:985-89.
2. Carrico, C. A., & O'Keefe, C. (2013). Protecting infants against pertussis: The cocooning strategy in practice. The Nurse Practitioner, 38(3), 40-45.
3. CDC - Pertussis: Fast Facts. (n.d.). Centers for Disease Control and Prevention. Retrieved from http://www.cdc.gov/pertussis/fast-facts.html
4. Help Silence the Sounds of Pertussis — Pertussis (Whooping Cough), Vaccine & Symptom Information. (2012, September 28). Retrieved April 25, 2014, from http://www.soundsofpertussis.com/what-is-pertussis.cfm
5. Murphy, T., Slade, B., Broder, K., Kretsinger, K., Tiwari, T., Joyce, M., . . . Iskander, J. (2008). Prevention of Pertussis, Tetanus, and Diphtheria Among Pregnant and Postpartum Women and Their Infants. Morbidity and Mortality Weekly Report, 57(4), 1-47.
6. National Conference of State Legislatures (NCSL). (April 2011). Immunizations Policy Issues Overview. Retrieved from: http://www.ncsl.org/issues-research/health/immunizations-policy-issues-overview.aspx
References
Preexposure Prophylaxis is used in high risk individuals
If anyone in the household has it, everyone should be treated
Especially if there are children under a year in the household
Isolation precautions for healthcare workers
Use isolation precautions consistently
Remind others to use isolation precautions if they aren't following the precaution guidelined
It's for your safety and the safety of your patients!
Educating family increases their knowledge of the risk pertussis poses to infant
EDUCATION increases willingness of parents/grandparents to get Tdap vaccine

We can make a difference as RNs through patient teaching!
Test Question #1:
What is cocooning?
A. Immunizing all the people in the household of an infant too young for the pertussis vaccine to create "herd immunity"
B. The name of the pertussis vaccine
C. The common name for pertussis
D. Swaddling the infant in a "cocoon" to protect them against pertussis
Answer: A
Test Question #2:
Why are infants under 2 months the highest risk group for contracting pertussis?
A. They don't like to get shots
B. There is no treatment for children this young
C. They are too young to be immunized against the disease
D. Infants aren't at risk for contracting pertussis
Answer: C
Serious complications for infants: pulmonary hypertension and bacterial pneumonia
Barriers to receiving the vaccination
Cost
Tdap (Boostrix & Adacel): $35-$45 (private sector)
DTaP (Deptacel, Infanrix, & Kinrix): $25-$50
New patient policies
may have to pay office visit charge
Convenience
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Full transcript