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Tdap coverage in a military beneficiary population: room for improvement

Sherrell T Lam1, Susan George, Susan Dunlow

  • 1Department of Medicine, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889.

Military Medicine
|October 3, 2013
PubMed

Insights

Pertussis vaccination rates for women of child-bearing age remain low despite recommendations. A targeted intervention showed a temporary increase in tetanus, diphtheria, and acellular pertussis (Tdap) vaccine uptake.

Area of Science:

  • Public Health
  • Immunization
  • Infectious Disease Epidemiology

Background:

  • Pertussis (whooping cough) is experiencing a resurgence, with adults and women of child-bearing age serving as key reservoirs due to waning immunity.
  • Low vaccination rates with the tetanus, diphtheria, and acellular pertussis (Tdap) vaccine persist, despite updated recommendations following infant deaths and outbreaks.

Purpose of the Study:

  • To assess the effectiveness of a performance improvement project aimed at increasing Tdap vaccination rates among women of child-bearing age.
  • To evaluate the impact of a targeted screening and referral system within a gynecology clinic on Tdap vaccination uptake.

Main Methods:

  • A performance improvement project was implemented at Walter Reed Army Medical Center, targeting women of child-bearing age in Gynecology clinics.
  • Electronic medical records were screened for Tdap vaccination status during vital signs assessment, with eligible patients referred to the Immunization Clinic.
  • Vaccination rates were analyzed 1 month before and 1 and 3 months after the intervention, defining success as vaccination within 30 days of the clinic visit.

Main Results:

  • Overall documented Tdap vaccination was low at 13.9% prior to the intervention.
  • The intervention led to a significant increase in 30-day Tdap vaccination rates, rising from 0.38% to 6.5% in the first month (p < 0.005).
  • The positive effect of the intervention waned by 3 months, with only 1.1% of patients vaccinated within 30 days, indicating low sustained uptake.

Conclusions:

  • The performance improvement project demonstrated a short-term increase in Tdap vaccination among women of child-bearing age but did not achieve sustained high vaccination rates.
  • Overall Tdap vaccination rates remain low, highlighting the need for further research into barriers to vaccination.
  • Addressing barriers to Tdap vaccination is crucial for preventing pertussis morbidity and mortality in infants and the wider community.

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