ED Nurses: Tdap vs. Td

ChristineN, BSN, RN · Jul 19, 2010

I know that they are strongly encouraging any healthcare workers that work with pediatrics to get the Tdap.

Editorial Team / Moderator · Jul 19, 2010

Yeah .... I blew it off when employee health first contacted us, but I'm going to make sure I get my Tdap. I've just been avoiding employee health because I don't want to get my varicella series again -- I had a nasty localized reaction to the second shot, but I've never had chickenpox and my titer revealed zero immunity. Bleh.

P.S. Congrats on the BSN!! I think you and I went back to school at the same time ... didn't you go to Chatham online for that? Sorry if I'm mis-remembering.

murphyle, BSN, RN · Jul 19, 2010

Tdap for us. We're also seeing a slight (now) resurgence of pertussis, particularly among populations who might not have been immunized as children or whose immunization might be wearing off r/t long-expired boosters. As a result, we ask twice at triage ("Are you up to date on vaccines?" and "When was your last tetorifice shot?"), and we offer Tdap to any patient who's timed out. It's amazing how many patients either flat-out don't know their immunization status, or say the last time they had "shots" was as a kid - however many decades ago that might have been.

As for pertussis and healthcare personnel, Tdap is the standard at my hospital's Employee/Occupational Health Services, and was "strongly recommended" as part of our immunization series for nursing school. (They'd accept Td, but given the choice they wanted you to go for the Tdap. Then too, Tdap was all the student health clinic offered, so the vast majority of us got it by default...)

dthfytr, ADN, LPN, RN, EMT-B, EMT-I · Jul 19, 2010

As a traveler I was required to get a TDaP. I've never seen a hospital giving it to patients, though. ["That wasn't chicken" fortune cookie]

Editorial Team / Moderator · Jul 20, 2010

["That wasn't chicken" fortune cookie]

suejara · Jul 20, 2010

I work in a large peds practice (10,000) newborns up to 23 years old. We only administed Tdap to our kids 11 years & up, unless there is some contraindication. Teens that had reactions to DTP as young children most likely did so because it was whole cell pertussis as opposed to acellular pertussis. We encourage parents to make sure they have had their booster.

I think Pertussis is making a come back in part because so many parents are deferring or completely refusing vaccines.

Get your TDaP!

Editorial Team / Moderator · Jul 20, 2010

The local ED where I take patients as a paramedic (not where I'm an RN) were using the acellular version and were using it on their peds -- 10 and up, maybe? -- and also on at-risk people, like a school bus driver.

I emailed my employee health RN today to arrange to get my Tdap next week! :)

Heatherheartsou, BSN, RN · Jul 20, 2010

Our ER currently only offers the Td vaccine. I am hopeful we will carry the Tdap soon.

mwboswell · Jul 20, 2010

Interesting that you bring this up - the revised immunization guidelines started 5 years ago! And like you've noticed, many ED's have not brought their vaccinations up to date with this. I'm not sure why, other than cost. If ED nurses are aware of the new guidelines, we probably should be advocating for this and getting our managers and directors to push for bringing us up to date with the guidelines. At my local facility, we are just starting to come around to this, and actually it was only when the pharmacy stated they were no longer carrying just the DT/Td....

Here's your original source citation that you can reference with the current guidelines for Tdap...

Vaccines: VPD-VAC/Combined/DTaP-DT-Td/Tdap main page

On June 30, 2005 the Advisory Committee on Immunization Practices (ACIP) voted to recommend the routine use of Tdap vaccines in adolescents aged 11-18 years in place of tetorifice and diphtheria toxoids (Td) vaccines.

On October 26, 2005 the ACIP voted to recommend routine use of a single dose of Tdap for adults 19-64 years of age to replace the next booster dose of tetorifice and diphtheria toxoids vaccine (Td). The ACIP also recommended Tdap for adults who have close contact with infants younger than 12 months of age.

mwboswell · Jul 20, 2010

Here's a follow up question...

Did you know it's a legal requirement that any vaccination you give, must be preceeded by providing the recipient with the appropriate vaccine immunization sheet (VIS)?

Not merely part of the discharge instructions, but it must be given before the vaccination and the pt. given a chance to read about it and have their questions answered? AND it should be documented in the record. I'll admit we're not 100% compliant with this....just food for thought.

Here's the reference for this...(this is just part of the whole webpage - you are encouraged to visit the web page and see more details)

Vaccines: Pubs/VIS/Fact Sheet

By

Federal law

, all vaccine providers must give patients, or their parents or legal representatives, the appropriate Vaccine Information Statement (VIS) whenever a vaccination is given.

What is a Vaccine Information Statement?

A Vaccine Information Statement (VIS) is a one-page (two-sided) information sheet, produced by CDC. VISs inform vaccine recipients-or their parents or legal representatives-about the benefits and risks of a vaccine. The law requires that VISs given out whenever certain vaccinations are given.

Who must give out VISs?

All provider of vaccines, both public and private sector.

Why must VISs be used?

It is a requirement of the National Childhood Vaccine Injury Act of 1986. Their purpose is to inform vaccine recipients, or parents of children getting vaccines, about the benefits and risks of vaccines.

When must VISs be given out?

They must be given out at the time of each vaccination-prior to administration of the vaccine.

Which VISs must I use?

A VIS must be provided for any vaccine that is covered by the Vaccine Injury Compensation Program (i.e., appears on the Vaccine Injury Table). As of June 2009, VISs that must be used are: DTaP, Td, MMR, Polio, Hepatitis A, Hepatitis B, Hib, Varicella, Influenza, and Pneumococcal Conjugate.

Other VISs that are available are Pneumococcal Polysaccharide, Meningococcal*, Tdap*, Rabies, Rotavirus*, HPV*, Shingles, Yellow Fever, Typhoid, Japanese Encephalitis, Anthrax, and Smallpox. Their use is not required by the National Childhood Injury Act, but is strongly encouraged - and they must be used when giving vaccines purchased through a CDC contract.