TDAP Immunization

mAGGI315 · May 25, 2010

All of our area hospitals offer it, and the patient doesn't have to sign a consent, but they really should.

Personally, I am not in favor of the idea. First of all, fever is a known side effect and pretty common. I think it's dangerous to have that in the postpartum phase, it confuses the infection issue.

Secondly, the woman already feels like crap, then we give her tetorifice, now her muscles ache and she feels like she has the flu and feels just miserable. Why do that to someone? Why not give it at her 6 week checkup? That would give her time to get used to being a mom, get breastfeeding established and then give the immunization.

I understand the community health issue, but I think in our overzealous attempt to get these vaccines, we are causing more problems and suffering. Just not a fan.

PedsAtHeart, LPN · May 25, 2010

The reason they want it given before their 6 week post partum is because an infant less that 6 weeks old has not had their Pertussis vaccine at all and mothers and close family contacts are the #1 source spreading it to these infants. I understand where you are coming from about the achiness and all that, but I would rather be a little sore and achey than take the chance of transmitting pertussis to my newborn. Personally, I received my Tdap a couple of months ago and had no reactions or side effects at all, no fever, no soreness.

To the OP, I do believe that most hospitals do offer this now.

klone, MSN, RN · May 25, 2010

Yes, and yes. Vaccines should ALWAYS require consents.

rickdon19 · May 25, 2010

Hi,

Thanks for all the response. Are you able to share your consent? Who gets it: RN or MD. Is there an information sheet that goes with it?

Thanks,

D

Faeriewand, ASN, RN · May 25, 2010

We students just learned about this too on our OB rotation. It's a new thing to keep parents from giving pertusis to their NB. They also ask that grandparents get it and anyone who might come in contact with the new babe. It was sad to learn about it because they had us read a sad story about a mom who didn't know she had it (had a cough) then had her baby and her baby got it and died. It was a good learning experience for us students. We will never forget that lesson.

PedsAtHeart, LPN · May 25, 2010

Pertussis is awful and no baby should ever have to go through it...

One thing I dont understand about Tdap is this... its only approved up to age 64. To me, the elderly population would also be at a higher risk of having complications from Pertussis, just like how the flu hits the youngest and the oldest hardest. I know this is simply because they have not done their clinical studies in that age group, but I really wish they would and open that age range up to EVERYONE. I think Tdap is an extremely important vaccine for health care workers to receive also.

As far as consents go, there is no federal law (might be a state law, depending on where you are at, you can always check with your state health department) saying that you must have a written consent for vaccines. BUT there is federal law stating that you MUST give out VIS (Vaccine Information Statements) with every vaccine that you give. The way we do this at my facility (I am Public Health Nurse and give all immunizations at my clinic) since we are total electronic charting, is that we document that the VIS was given, the date of the VIS, and all the typical info you document for your injections. Then we also make a note in our nurse's note that consent was given for said vaccine. As far as WHO gets the consent if you do have written consent forms, it can be either the Dr or the nurse giving the vaccines.

klone, MSN, RN · May 25, 2010

The consent is obtained by the RN. Yes, there is an information sheet that goes with it - the VIS that the CDC publishes. There is a VIS for every vaccine offered, and IMO we're obligated to give that to the patient to read prior to obtaining the consent. It's a state law that we have to provide the VIS (may even be a federal law, I'd don't know).

You can download copies of the VIS for each vaccine at the CDC website:

Vaccines: Pubs/VIS Mobile Downloads

mAGGI315 · May 25, 2010

My problem with this new recommendations is that hospitals tend to pick and choose, if we are going to follow the recommendations and make a "campaign", then do so to the fullest.

This means that

-ALL health workers need to be up to date with the Tdap and MMR, otherwise, you and your facility could be exposing babies.

-ALL family members should be up to date. Is your facility giving out information stressing the importance to other family members? If our goal is to really make a dent and prevent it, why do it half way? Why not make up some handouts and show the importance for all family members. That's the recommendation, not just new moms.

And as an FYI, the current statistic is 30 deaths in the neonatal period PER YEAR...so statistically, giving the shot is not going to make a huge difference if you look at how many babies are born, how many die from other causes.

If you look at how many women get infections, if you look at the fact we are somewhere like 18th on mortality in mothers, then anything that could potentially hide an infection (such as fever, chills, pain, etc) is a huge risk factor that should be eliminated.

Sometimes I think we do things to make ourselves feel better, but we don't really take the time to look at all the evidence and really stop to look at it from a common sense approach. We'd save more than 30 lives a year doing so many other common sense things, and if we're doing to do the vaccination promotion, then just giving the moms the shots without following the FULL RECOMMENDATIONS is really just fooling ourselves and giving ourselves a pat on the back. If the health care workers are walking around not up to date and we aren't pushing the other family members who are in the home, then we aren't making a difference. We're just making mom's uncomfortable and possibly could see more than 30 moms get sick or die over a year's time from masked infection (we've already had 2 in our facility, so I'm sure the numbers will be there over the whole country).

And giving a mom the VIS while she's recovering from birth, on narcotics, hasn't slept, and often giving it to her right as we're prepping the shot is a joke as far as informed consent. Informed consent should never be given when mom is under the influence of narcotics. We do it all the time in ob, especially with such short stays. These are moms who have been given huge packets of information, bombarded with all kinds of educational materials, and we hand them some information about vaccines, and then give them the shot a few minutes later, and think we gave them informed consent. I find that we should at least be embarassed by that and at worst should be thinking about malpractice if there's a reaction and mom can't even remember it and you find out she just had percocet 2 hours ago.

PedsAtHeart, LPN · May 25, 2010

My problem with this new recommendations is that hospitals tend to pick and choose, if we are going to follow the recommendations and make a "campaign", then do so to the fullest.
This means that
-ALL health workers need to be up to date with the Tdap and MMR, otherwise, you and your facility could be exposing babies.
-ALL family members should be up to date. Is your facility giving out information stressing the importance to other family members? If our goal is to really make a dent and prevent it, why do it half way? Why not make up some handouts and show the importance for all family members. That's the recommendation, not just new moms.
And as an FYI, the current statistic is 30 deaths in the neonatal period PER YEAR...so statistically, giving the shot is not going to make a huge difference if you look at how many babies are born, how many die from other causes.
If you look at how many women get infections, if you look at the fact we are somewhere like 18th on mortality in mothers, then anything that could potentially hide an infection (such as fever, chills, pain, etc) is a huge risk factor that should be eliminated.
Sometimes I think we do things to make ourselves feel better, but we don't really take the time to look at all the evidence and really stop to look at it from a common sense approach. We'd save more than 30 lives a year doing so many other common sense things, and if we're doing to do the vaccination promotion, then just giving the moms the shots without following the FULL RECOMMENDATIONS is really just fooling ourselves and giving ourselves a pat on the back. If the health care workers are walking around not up to date and we aren't pushing the other family members who are in the home, then we aren't making a difference. We're just making mom's uncomfortable and possibly could see more than 30 moms get sick or die over a year's time from masked infection (we've already had 2 in our facility, so I'm sure the numbers will be there over the whole country).
And giving a mom the VIS while she's recovering from birth, on narcotics, hasn't slept, and often giving it to her right as we're prepping the shot is a joke as far as informed consent. Informed consent should never be given when mom is under the influence of narcotics. We do it all the time in ob, especially with such short stays. These are moms who have been given huge packets of information, bombarded with all kinds of educational materials, and we hand them some information about vaccines, and then give them the shot a few minutes later, and think we gave them informed consent. I find that we should at least be embarassed by that and at worst should be thinking about malpractice if there's a reaction and mom can't even remember it and you find out she just had percocet 2 hours ago.

I don't work OB, never have, and I really have no desire to, so this is based on my own personal experience. I had c-sections with both of my children. On the day I was discharged from the hospital, on both occasion, I was more than lucid enough to read a paper and make an informed decision about whether I wanted a vaccine or not.

And if those 30 something deaths per year could be prevented? Why not? I mean seriously... I give Tdap vaccine to patients ALL the time, I have yet to even have 1 single person who had reactions bad enough to even call the office afterward. I don't think its going to mask any underlying infection in a post partum mom. Obviously if mom starts running a fever and having s/s of infection, whether she got Tdap or not, she should be evaluated by a Dr.

I do agree with you in the regards to complying with the full recommendations of the vaccine. Every 11 or 12 year old should be boostered with a Tdap and anyone older than that who has had a Td >2 yrs ago should be boostered with a Tdap. For instance, if I see a new parent in my clinic with their 2 month old child for immunizations, I should check her Tdap status while she is here with child and fathers status and the status of any sibling. BUT I work in a Native American clinic, so if one parent is not native then all I can do is advise them of the importance of being vaccinated and following up with their own private physician.

Obviously, I'm very pro-vaccine. Its what I do every single day. For me, the benefits far outweigh the risks. On another personal note, I have been administering vaccines for 8 years now and I have yet to have a patient have any serious side effects to any of them *knock on wood* I pray that it never happens. As medical professionals it is our obligation to make sure that our patients are informed of the risks/benefits of anything we do. I would say that if you feel a mother is not in the right state of mind to make that decision when she is leaving the hospital, then by all means, wait until her follow up appt. and do it at that time.

Elvish, BSN, DNP, RN, NP · May 25, 2010

We don't give out TdaP to women on the postpartum floor. We do give out MMR and during flu season we did flu vaxes too. Usually it's the RN that gets the consent signed, and we give out VISs too. I don't like giving out the MMR for the same reasons others mentioned about not liking giving the TdaP. I'm generally in favor of vaccines but some of the side effects can mimic infection symptoms - it has happened, and what usually ends up happening is mom ends up on IVFs and IV abx unnecessarily until the docs r/o infection. (I mean, we nurses generally know the difference, but the docs feel like they have to cover their butts.)

klone, MSN, RN · May 25, 2010

I'm generally in favor of vaccines but some of the side effects can mimic infection symptoms

Yep, at my last facility, when we'd have to give the rubella vaccine, we would do it last thing, practically just as she was walking out the door.