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Two leading infection control and immunization advisory committees at the Centers for Disease Control and Prevention have jointly endorsed new guidelines to give the new Tdap vaccine to health care workers to protect them and their patients from pertussis.

CDC: implementing Tdap shots, PEP strategies after exposure

CDC: implementing Tdap shots, PEP strategies after exposure

Draft says PEP necessary unless worker followed

Two leading infection control and immunization advisory committees at the Centers for Disease Control and Prevention have jointly endorsed new guidelines to give the new Tdap vaccine to health care workers to protect them and their patients from pertussis. The draft guidelines, which are expected to be finalized soon, include the following excerpted highlights:

Infrastructure for screening, administering and tracking vaccinations exists at occupational health or infection prevention and control departments in most hospitals, and is expected to provide the infrastructure to implement Tdap vaccination programs. New personnel can be screened and vaccinated with Tdap when they begin, according to current recommendations. As Tdap vaccination coverage in the general population increases, many new health care personnel (HCP) will have already received a dose of Tdap.

To achieve optimal Tdap coverage among personnel in health care settings, health care facilities are encouraged to utilize strategies which have been shown to enhance HCP participation in other hospital vaccination campaigns. Successful strategies for hospital influenza vaccine campaigns have included strong proactive educational programs designed at appropriate educational and language levels for the targeted health care workers, vaccination clinics in convenient locations, vaccination at worksites, and provision of vaccine at no cost to the workers. Some health care institutions might favor a tiered approach to Tdap vaccination with priority given to HCP who have contact with infants less than 12 months of age and other vulnerable groups of patients.

Purchase and administration of Tdap for HCP is an added financial and operational burden for health care facilities. A cost-benefit model suggests that the cost of a Tdap vaccination program for HCP is offset by reductions in investigation and control measures for pertussis exposures from HCP, in addition to the anticipated enhancement of HCP and patient safety.

Health care facilities could realize substantial cost-savings if exposed HCP who are already vaccinated against pertussis with Tdap were exempt from control interventions. However, the current CDC guidelines for control of pertussis in health care settings were developed before Tdap was available for adults. Studies are needed to evaluate the effectiveness of Tdap to prevent pertussis in vaccinated HCP, the duration of protection, and the effectiveness of Tdap in preventing infected, vaccinated HCP from transmitting pertussis to patients and other HCP. Until studies define the optimal management of exposed, vaccinated HCP, or a consensus of experts is developed, health care facilities are advised to continue post-exposure prophylaxis for vaccinated HCP who have unprotected exposure to pertussis.

Alternatively, each health care facility can determine an appropriate strategy for managing exposed, vaccinated HCP based on available human and fiscal resources and whether the patient population served is at risk for severe pertussis if transmission were to occur from an unrecognized case in a vaccinated HCP.

Some health care facilities might have infrastructure to provide daily monitoring of exposed, vaccinated HCP for early symptoms of pertussis, and for instituting prompt assessment, treatment and administrative leave, if early signs or symptoms of pertussis develop. Daily monitoring of HCP for 21 to 28 days before beginning each work shift has been successful with vaccinated workers exposed to varicella, and for monitoring the site of vaccinia (smallpox vaccine) inoculation. Daily monitoring of pertussis-exposed HCP who received Tdap might be a reasonable strategy for post-exposure management, considering the incubation period of pertussis is up to 21 days and the minimal to no risk of transmission before the onset of signs and symptoms of pertussis. In considering this approach, hospitals should maximize efforts to prevent transmission of pertussis to infants or other groups of vulnerable persons. Additional study is needed to determine the effectiveness of this control strategy.