Pertussis Vaccination of Infant Caregivers in the Pediatric Office Setting

Project by Lisa Akhtar, MD, PhD, and Emily Duffy, MD, with faculty Kristen Feemster, MD, MPH, and Andrea McGeary, MD

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News from the Pediatrics Residency Program

Pertussis infection, which is a vaccine-preventable disease, causes a severe respiratory illness in young infants. However, the infants at highest risk of severe disease and death are too young to be vaccinated. Therefore, the American Academy of Pediatrics recommends that the youngest infants be protected via a “cocooning” strategy, by immunizing all infant contacts against pertussis, including parents, grandparents, siblings, and out-of-home caregivers. However, many barriers to adult vaccination exist that limit the effectiveness of this “cocooning” strategy.

To address this problem, a team of residents and attending physicians organized a needs assessment of the local population to determine what the critical barriers to infant caregiver vaccination are, and what mechanisms could be used to overcome them. This project became an ongoing community outreach effort for the next several years.

They found that the majority of caregivers would not be willing to present to a local retail pharmacy for vaccination even if vaccination was free of charge. The data suggested that ensuring convenience is the key to increasing infant caregiver vaccine uptake, and that offering vaccination in the pediatric office setting may be an effective mechanism for overcoming barriers to convenience.

In the fall of 2014, Drs. Dalembert, Kallem and Martin began a pilot project to determine whether offering caregiver pertussis vaccination in the pediatric office setting was sufficient to increase caregiver vaccine uptake in the West Philadelphia community. The pertussis vaccination is now offered to all unimmunized adult caregivers presenting to the CHOP Primary Care, Cobbs Creek location for the initial newborn visit over a one-month period.

The team also collected information on how willing caregivers were to receive vaccination and what barriers are still present. Funding was obtained to offer vaccination free of charge from the CHOP Cares Community Fund. This pilot study has provided valuable information regarding the feasibility and acceptability of offering pertussis vaccination in the pediatric office setting as a potential strategy to overcome barriers to infant caregiver vaccination. The resident team has piloted this program in the other resident primary care clinics at Karabots and South Philadelphia.

Drs. Dalembert, Kallem and Martin presented their work at the Eastern Society for Pediatric Research in Philadelphia, PA, and also at the Pediatric Academic Societies (PAS) poster session in San Diego, CA, and were awarded for outstanding community service by the AAMC. 

About Resident Senior Advocacy Projects: At Children’s Hospital of Philadelphia, the Community Pediatrics and Advocacy Program (CPAP) integrates an expanded focus on advocacy and community-based pediatrics into pediatric resident training. Senior Advocacy Projects are the capstone of the CPAP curriculum and training. 

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