Vaccinating Healthcare Workers for Pertussis: A Shared North American Experience

ISSUE: Healthcare workers (HCWʹs) with Bordetella pertussis pose a serious threat to susceptible patients and HCWʹs. When Tetanus Toxoid and Reduced Diphtheria Toxoid and Acellular Pertussis vaccines (Tdap) were approved in the US for adolescents and adults in 2005, our hospital was one of the first to target HCWʹs for immediate vaccination and establish a process to routinely offer Tdap to all HCWʹs. PROJECT: Guidance for vaccinating adults with Tdap in the US had not been published when the vaccine was initially available. 2 HCWʹs from our neonatal intensive care (NICU) and birthing center had exposed 32 staff and 25 patients, including 11 newborns. Because staff in obstetrics, NICU, pediatrics, urgent care and emergency department provides most of the care for patients at high risk of pertussis, our hospital recommended immediate vaccination of those HCWʹs. Our decision was based on vaccine manufacturerʹs data, CDC expertise, and experiences described by a Montreal pediatric center, which began pertussis immunizations for HCWʹs in 2005 following recommendations issued in Quebec in 2004. All HCWʹs are now offered Tdap during annual employee health assessments with eligibility for Tdap based on the interval since the last Tetanus Diphtheria (Td) booster. At our hospital, staff are vaccinated if ≥5 years since last Td; counseled and likely vaccinated if ≥3 but <5 years since last Td; and not vaccinated if <3 years since last Td. The time interval requirement differs from the Montreal pediatric center, where HCWʹs may be vaccinated regardless of time interval from last Td booster. RESULTS: 70 HCWʹs have been vaccinated at our hospital and 90 HCWʹs from the Montreal pediatric center. Intervals between a Td and Tdap were ≥4.5 years at our hospital and at Montreal pediatric center, no time was required, thus not reported. At our hospital, 2 (2.9%) HCWʹs reported high fever and malaise within 48 hours. However, the 2 persons with fever were among a group of HCWʹs that received influenza vaccine concurrently. Causal factors for the reactions have not been assessed. No adverse reactions were reported by HCWʹs at the Montreal pediatric center. LESSONS LEARNED: HCWʹs are receptive to vaccination with Tdap. Networking with experts can provide information and confidence when implementing a new infection control process. Vaccination with Tdap is a patient safety initiative that may reduce B. pertussis in HCWʹs and patients.