Tdap immunization in pregnancy: provider compliance with CDC guidelines


Department of Obstetrics and Gynecology, Aurora Sinai Medical Center, Center for Urban Population Health

Presentation Notes

Presented at 2014 Aurora Scientific Day, Milwaukee, WI


Background: Pertussis, also known as whooping cough, is a highly contagious, acute respiratory illness. In children and infants, morbidity is more often substantial and the disease may be fatal. There has been a steady increase in reported cases in the United States (27,550 in 2010 vs. 41,000 in 2012). Mothers were responsible for 30-40% of infant infections when the source of pertussis was identified. In October 2012, the Centers for Disease Control and Prevention (CDC) and Advisory Committee for Immunization (ACIP) recommended that caregivers provide a Tdap immunization for all pregnant women for each pregnancy, irrespective of the patient’s prior history of receiving Tdap.

Purpose: Evaluate provider compliance with Tdap immunization guidelines at four different time periods: prior to change in CDC guidelines, immediately after change, 5 months after change/educational intervention, and 1 year after change.

Methods: Records review of 400 random charts, 100 in each of the above categories from 2012 to 2013. Excluded were patients without an appointment during the 27-36 gestational weeks. Educational lecture and survey was provided to all staff of the Women’s Health Center regarding Tdap immunization changes. Compliance rate was calculated for each time period. Two-sample t-test was used to compare compliance rates, and chi-square test with Yates correction for 2 × 2 tables.

Results: Compliance rate was 62% prior to change, 39% immediately after change, 50% at 5 months after change/ intervention, and 72% at 1 year after change. Odds ratios for the three time periods were: 1.00, 1.62 and 4.14, respectively (P=0.00000). The vaccine was received appropriately in the immediate postpartum period in 32% prior to change, 43% immediately after change, 44% at 5 months after change/intervention, and 13% at 1 year after change. Resident physicians answered 63% correct and faculty physicians answered 67% correct regarding frequency and timing of Tdap vaccination survey questions; however, the residents were more compliant (60% vs. 52%) in actual clinical practice.

Conclusion: Educational intervention and time had a statistically significant impact in improving compliance rate. Appropriate vaccination during the postpartum period and adequate documentation are areas of improvement.

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