632. Effectiveness of Hospital-Based Procedures on Postpartum Vaccination with Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis (Tdap) and Seasonal Influenza (sTIV)
Session: Poster Abstract Session: Pediatric Vaccines
Friday, October 21, 2011
Room: Poster Hall B1
Handouts
  • 632_SylviaYeh.pdf (305.0 kB)
  • Background: Due to increased morbidity and mortality of the infections, Tdap and sTIV vaccination during pregnancy is recommended but compliance has been poor (<25%). Postpartum (PP) vaccination is recommended for those not previously vaccinated; but effective procedures for vaccinating have not been well studied.

    Methods: From Oct 2009 to Jul 2010 we performed a prospective, controlled evaluation of PP Tdap and sTIV vaccination at two private Los Angeles community hospitals with >2000 births/year. At Hospital A (HspA), physician opt-in orders for Tdap and sTIV vaccination before discharge were implemented Nov 2009, followed by standing orders in Feb 2010. At Hospital B (HspB), no intervention was done. Randomly selected hospital charts were reviewed for receipt of Tdap and sTIV and demographic data. Multivariate analyses evaluated characteristics associated with sTIV vaccination prior to delivery and PP.

    Results: We reviewed 1252 charts (648 HspA, 605 HspB). The rates of self-reported sTIV receipt prior to delivery were 52% and 22%, Hsp A and B, respectively (p<0.0001). Initial sTIV PP vaccination rate at HspA for women with no prior receipt was 47% (Oct/Nov). After use of the order sets, the rate peaked at 42% (Jan) with a rate of 28% from Dec through Apr, p=0.07. At HspB, 0% received PP sTIV. Tdap self-reported vaccination rate at HspA prior to delivery was 4.6% and PP vaccination of eligible women was 25%. Tdap PP vaccination increased with the introduction of the opt-in order set (from 0% to 18%), with a greater increase following the standing order (up to 62%), p< 0.0001. HspB did not document Tdap receipt prior to delivery and no Tdap was given PP. Multivariate analyses revealed that admission to HspB and Medi-Cal coverage were independently associated with lower sTIV vaccination prior to delivery (OR 0.3, 95% CI 0.2,0.3, & OR 0.5, 95% CI 0.3,0.8, respectively). Maternal race, insurance plan, age, & parity had no impact on PP sTIV vaccination rate. 

    Conclusion: Hospital-based PP vaccination was effective in increasing Tdap coverage, but had little effect for sTIV, possibly due to unusually high pre-delivery sTIV vaccination. Delivery hospital and Medi-Cal insurance were associated with lower pre-delivery vaccination, but not for hospital-based PP vaccination.  


    Subject Category: I. Adult and Pediatric Vaccines

    Sylvia Yeh, MD1, ChrisAnna M. Mink, MD1, Matthew Kim2, C. Scott Naylor3 and Kenneth Zangwill, MD1, (1)Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, (2)Cedars-Sinai Medical Center, Los Angeles, CA, (3)Providence Medical Center at Little Company of Mary, Torrance, CA

    Disclosures:

    S. Yeh, None

    C. M. Mink, None

    M. Kim, None

    C. S. Naylor, None

    K. Zangwill, Novartis Vaccines: Research Contractor, Research support
    Pfizer: Research Contractor, Research support
    Merck & Co.: Scientific Advisor, Consulting fee

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