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Discussion

DTaP booster

The fairly recent increase in the incidence/awareness of pertussis had led to many family doctors and OB-GYNs recommending booster shots for those involved in the care of young children. The actual recommendation is that all adults receive this vaccine at least every 10 years.

We have recently had two suspected pertussis (one confirmed) cases on our unit, and it became apparent how few nurses and doctors were actually up to date on their vaccine. One patient (the confirmed case) spent several hours in our ER and nearly 12 hours in our PICU before droplet precautions were initiated for suspected pertussis. Now, every staff member who came within three feet of the patient without a face mask needs prophylactic treatment (course of Azithromycin and a booster). The more unfortunate fact is the possible cross-contamination that occurred since the patient wasn't promptly placed on droplet isolation.

While I had planned on getting the DTaP booster due to my pregnancy anyway, I was not aware that a booster was recommended every ten years. I was discussing with the employee health MD why this was not a required titer/immunization before starting employment. (Hepatitis B and MMR are required titers, as is a PPD). Her answer, which seems pretty lame, was that most people don't like painful shots.

But it got me thinking- has your hospital instituted a policy regarding getting a TDaP booster, given that pertussis outbreaks are becoming increasingly common? Are employees encouraged or required to get a booster, if they haven't had one recently?

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    I haven't worked in a hospital in years, but our state has updated school immunization requirements to reflect the growing incidence of pertussis in the community.

    We used to accept a DT vaccine, but no longer will, without medical justification or notarized religious exemption. Pertussis must now be included in the kindergarten and middle school vaccine schedules.

    Ironically, I don't know of any requirement that the staff update their vaccines on a regular basis.

    Our family doctor is extremely conscientious about vaccine updates with every visit. I give her a lot of credit for the teaching and advocacy she provides on the subject.

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    Tetorifice has always been recommended every 10 years but I've never heard of a recommendation that all adults get pertussis boosters that frequently. I had a TDaP when there was a pertussis outbreak in my hospital in 2006 and I'm sure that when I'm due for a booster, I'll get that as opposed to just the Td since I work with children.

    I honestly doubt that my hospital kept that close track of when staff were due for tetorifice boosters... when I had to go to occupational health for clearance to work after being placed on lifting restrictions a few years ago (I'd worked there for 2 1/2 years at the time), they didn't have my file because they'd "lost" it.

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    When I started at my Peds hospital I received the TDaP booster since I couldn't remember when I had my last tetorifice shot. If I remember correctly, the employee health nurse told me that since I also hadn't had a pertussis booster ever that I would get the TDaP this time, but the next time I needed a tetorifice shot, thats all I would get. I think you just need the pertussis one more time after childhood.

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    I have not heard of this but I have a physical coming up and maybe I will ask when/if I last had it since I can't remember.

    We had a baby with pertussis in the NICU a few years back, ended up on ECMO and eventually dying. I don't remember what, if anything, staff was told regarding vaccination, I do know that the baby this patient had initially been paired with prior to crashing was prophetically treated (so maybe the RN's and others were too? I can't remember and didn't care for her). There was also an issue of non compliance of the patients family with adhering to isolation, ultimately some other patients/family elsewhere in the hospital also needed prophylactic treatment :uhoh3:

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    Our hospital just introduced a multi-tier policy. Tier one states that all nurses that all staff that works in the pediatric areas have to have the vaccine. The next stages involve the adult nurses then the remainder of the hospital staff. If people refuse they are terminated.

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