The Newsletter for SUNY Downstate
University Hospital of Brooklyn
ISSUE 19 NOVEMBER 2013
Bordetella Pertussis (Whooping Cough)
By Leone Waltrous, MD, MPH
Clinical Assistant Professor, Obstetrics
Cases of Bordetella Pertussis (the cause of whooping cough), rose significantly between 2009 and 2012 across the United States. According to the New York State Department of Health and the CDC, New York State has the dubious honor of having the third highest number of cases nationally.
From 2011 when 900 cases were documented, the number of cases in New York State ballooned to 2,649 in 2012. Due to an aggressive campaign launched by the Department of Health to immunize the public, the number of cases has decreased for 2013.
What is the cause of this seemingly quiet storm?
Waning immunity is one of the suspects. Some experts believe that the protection from the pertussis vaccine we received as children lasts only 5 to 10 years on average. So as adults, we need to get vaccinated with Tdap.
The sad problem is that our children are the ones in danger. Nationwide, last year 110 babies under 1 year of age were affected. Unlike other years, no deaths were reported so far in 2013. However, Bordetella Pertussis (Whooping Cough) in 2012, 15 infant deaths were reported. The majority of these were in children less than 3 months of age. These deaths were preventable.
Since children lack immunity until their first Tdap shot at the age of 3 months, it is important for the adults caring for and surrounding them to be immunized to protect themselves and the baby from becoming ill. This is called "cocooning." This same concept applies to the influenza vaccine. Babies cannot be immunized with the influenza vaccine unil the age of 6 months.
In 2012, Governor Andrew Cuomo signed a law which "require(s) all general hospitals with newborn nurseries or obstetric services to offer and provide vaccination against Bordetella Pertussis (whooping cough) to parents and anticipated caregivers of all newborns being treated in the hospital following their births." Physician endorsement and high staff vaccination rates are two of the strategies that will lead to success.
Our obligation to successfully treat our patients is paramount. Do not forget that in this era of pay-for-performance that our reimbursement will depend not only upon patient satisfaction scores, but also the ability to implement evidence-based guidelines into our practices.
By our actions in this regard, let us make apparent to our community that SUNY Downstate continues to serve our patients.
Here at SUNY Downstate, a multidisciplinary team including Infection Control, Performance Improvement, Regulatory Affairs, Pharmacy, Obstetrics & Gynecology, Nursing, Employee Health, Registration, Billing and Pediatrics has been meeting to discuss effective ways to accomplish our goals. To date, lectures have been given to nurses on Labor & Delivery, the Neonatal Intensive Care Unit, Housekeeping, and the Hospital Police Force. A presentation was made to the Provision of Care Committee and to the Executive Performance Improvement Committee.
Cards with bullets about Tdap on one side, and the influenza vaccine on the other, are handed to the patients in the Suite G Ambulatory Unit to promote discussions between the patients and medical providers. Another successful intervention utilized at other hospitals, and one under consideration here, is having pre-printed orders in the postpartum area.
The group is in the process of developing policies and procedures to address this issue. A follow-up presentation to the Provision of Care Committee on needed policy revisions should take place in the upcoming weeks. Hopefully the dedication from this group, and the emergence of more champions, will make this a satisfying and productive collaboration.