Let's Make it Easier for Caregivers to Protect Infants from Whooping Cough
By Deepa Camenga, MD, Robert Wood Johnson Foundation Clinical Scholar
When I was pregnant with my first child, my husband and I diligently prepared for our new baby. We studiously researched the safest car seats, cribs and strollers, we took labor classes to prepare for the birth, and we ate a healthy diet. My husband accompanied me to every OB/GYN visit, and we both listened closely when the doctor recommended that we should both receive the flu and Tdap (Tetanus, diphtheria, and pertussis) vaccine.
Tdap protects against pertussis, or whooping cough, a debilitating respiratory infection that can be fatal in young infants. I had received Tdap during my pediatric residency as recommended by the hospital, and my OB/GYN provided the flu vaccine, but my husband, an overall healthy guy, had not seen a doctor in years and had not received Tdap. He went to our local pharmacy for a flu shot, so I could check that off our list, but as the months moved forward, still no Tdap.
Fast forward to the delivery, when upon discharge our nurse again reminded us about Tdap. I’m sure it sank in somewhere, but it was quickly forgotten when we pulled into our driveway and realized we didn’t know how to remove our son from the car seat. The weeks that followed quickly turned into months…and years. Ultimately, it took a full two years—and the birth of our second son—before my husband was finally vaccinated.
I’m sure this experience is shared by many new parents. It was no surprise to me when I learned that few eligible adults in the United States receive the Tdap vaccine.
The Centers for Disese Control and Prevention recommends pertussis vaccination for adults in close contact with newborns. The immunization of household contacts provides early protection for infants, who do not gain immunity to pertussis until they have received at least two doses of diphtheria, tetanus, and acellular pertussis (DTaP) vaccine at about 6 months of age. Even though most adults have received the childhood DTaP vaccination series, immunity to pertussis wanes approximately 5 to10 years after the completion of childhood vaccination, and adults need to receive a booster vaccination to protect themselves and prevent transmission to the infant.
Data from the 2010 National Health Interview Survey show that only 10.6 percent of adults between the ages of 19 and 64 who have close contact with an infant have received the Tdap vaccine. The rate of Tdap vaccination has not increased greatly from 2006, when it was first recommended for infant caregivers.
There are several reasons why the adult Tdap vaccination rate remains low. Many adults who regularly care for infants lack insurance coverage or access to care. Adults without insurance do not have the same access to vaccines as children, who can receive free vaccines through the federally funded Vaccines for Children program. Furthermore, many parents may be otherwise healthy and may not regularly utilize health care, even if they have insurance.
Another problem is that it is not convenient for busy parents to access the Tdap vaccine. Unlike the flu vaccine, which is increasingly available in pharmacies, workplaces, or other community locations, the Tdap vaccine is only available in health care settings.
In our study, published in Academic Pediatrics, we tried to increase the convenience of receiving the Tdap vaccine by offering the vaccine to infant caregivers who came to their newborns’ two-week well-child exam at their pediatricians’ offices. This model of vaccine delivery targets adults during early parenthood, a window of opportunity in which even uninsured adults may have frequent contact with the health care system through visits with their children.
We found that 69 percent of infant caregivers accepted and received the Tdap vaccine when it was offered by their pediatricians. Furthermore, a large proportion of non-mother infant caregivers presenting at the two-week visit did not receive routine medical care (23 percent) or did not have insurance (38 percent), which suggests that these caregivers may not otherwise have access to the Tdap vaccine. These findings suggest that parents and caregivers are generally open to being vaccinated but may lack health care access and convenient opportunities to receive the vaccine.
In our study, pediatricians made strong recommendations for parents to receive the Tdap vaccine. Strong provider recommendations may be one of the biggest factors in patient acceptance of the Tdap vaccine.
It sure worked for my family. Even though I am a pediatrician and a Tdap researcher, I couldn’t persuade my husband to make a doctor’s appointment to get the vaccine. In the end, it took the recommendation from our son’s pediatrician and the convenience of an on-site vaccination clinic for my husband to finally be vaccinated. Increasing the convenience and accessibility of the Tdap vaccine may ensure that all parents receive this important vaccine and protect themselves and their infants from pertussis.