Pertussis disease in new mothers: effect on young infants and strategies for prevention.
ABSTRACT Pertussis, or whooping cough, is a major public health problem in the United States, with the incidence of disease and its associated complications having significantly increased in the adolescent and adult populations. These populations serve as the major transmission source of the disease to young infants, a group that is at the highest risk of severe morbidity and mortality from the disease. Studies have shown that new parents, especially mothers, are the source of disease transmission in more than 50% of the cases. Tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis booster vaccines (Tdap) are licensed for use in adolescent and adult populations. The Centers for Disease Control and Prevention (CDC) recommends that the Tdap vaccine be given to postpartum women as soon as possible after delivery and before hospital discharge to protect them and their newborns against pertussis disease. The American College of Obstetricians and Gynecologists recommends that its membership follow the CDC recommendations. This article includes a further discussion of the rationale for this recommendation and provides possible strategies for vaccine implementation.
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ABSTRACT: There is a substantial gap between those people in the United States who identify as being favorable toward organ donation (~90%) and those registered as donors (~30%). A growing body of evidence suggests Department of Motor Vehicles (DMV) offices are effective sites for facilitating higher organ donor registration rates on a national scale. The goal of the current study was to determine the utility and sustainability of a message immediacy approach, which draws from theoretical concepts such as priming and cues to action. Message immediacy requires individuals be: (a) exposed to a message that prompts an action, (b) in an environment where a prescribed action or behavior can be enacted, and (c) favorable toward the promoted behavior or action. Thirty-four Michigan counties, divided into three implementation groups, received campaigns in October (Group 1), November (Group 2), and December (Group 3) of 2009. Registration rates for three to six months after campaign implementation indicate that the on-site message prompts almost doubled registration rates in DMV offices. Additionally, preliminary cost-effectiveness evidence suggests message immediacy offers a relatively inexpensive campaign strategy.Journal of Applied Communication Research 08/2012; 40(3). DOI:10.1080/00909882.2012.670258 · 0.68 Impact Factor
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ABSTRACT: Pertussis has been on the rise worldwide for more than 20 years. Waning immunity may be the major cause for the resurgence of this disease. Adolescents and adults have become the vectors of pertussis, with newborns and infants less than 12 months of age at greatest risk for morbidity and mortality. Health care providers need to become aware of a vaccine strategy called cocooning that provides the needed vaccines to individuals who have contact with newborns and infants. Cocooning can protect our most vulnerable populations from pertussis and other vaccine -preventable diseases in the 21st Century.Journal of midwifery & women's health 05/2013; 58(3):288-96. DOI:10.1111/jmwh.12045 · 1.04 Impact Factor
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ABSTRACT: To evaluate whether use of a computer-based clinical decision-support algorithm that used data stored in the electronic medical record increased administration of tetanus, diphtheria, and acellular pertussis (Tdap) vaccine to postpartum women. We performed a before and after cohort study of postpartum women at an urban public teaching hospital. We compared the frequency of Tdap vaccination during the preintervention (October 1, 2008-January 14, 2009) and postintervention (January 15-April 30, 2009) time periods. We intervened by automating electronic presentation of preselected orders to physicians who provided postpartum care. The order was displayed when physicians ordered iron supplementation or patient discharge to a woman who met certain criteria. We evaluated whether patient characteristics were associated with receipt of vaccine. Tetanus, diphtheria, and acellular pertussis vaccination was more likely for postpartum women postintervention compared with preintervention (147 of 248 [59%] compared with zero of 183 [0%]; difference=59%; 95% confidence interval [CI] 53-65%). Among 248 women who delivered during the postintervention period, those who met pharmacologic criteria for decision support rule activation were vaccinated more often than those who did not meet criteria (146 of 232 [63%] compared with one of 16 [6%]; difference=57%; 95% CI 43-70%). Race and ethnicity and cesarean delivery were not associated with vaccine receipt; however, there was a lower likelihood of vaccination among older women (P=.05 by a trend test across age quartiles). We implemented a computer-based clinical decision-support algorithm that dramatically increased Tdap vaccination of postpartum women. Deployment of our algorithm in hospitals that have clinical decision support systems should increase rates of this important postpartum preventive intervention. II.Obstetrics and Gynecology 07/2010; 116(1):51-7. DOI:10.1097/AOG.0b013e3181e40a9f · 4.37 Impact Factor