Tdap Vaccination Among Healthcare Personnel, Internet Panel Survey, 2012-2014

INTRODUCTION

Healthcare personnel (HCP) are at risk for pertussis infection exposure or transmitting the disease to patients in their work settings. The Advisory Committee on Immunization Practices recommends tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccination for HCP to minimize these risks. This study assessed Tdap vaccination coverage among U.S. HCP by sociodemographic and occupation-related characteristics.

METHODS

The 2012, 2013, and 2014 Internet Panel Surveys were analyzed in 2015 to assess HCP Tdap vaccination. Effective sample sizes for 2012, 2013, and 2014 survey years were 2,038, 1613, and 1633, respectively. Missing values were assigned using multiple imputation. Multivariable logistic regression identified factors independently associated with HCP Tdap vaccination. Statistical measures were calculated with an assumption of random sampling.

RESULTS

Overall, Tdap vaccination coverage among HCP was 34.8% (95% CI=30.6%, 39.0%); 40.2% (95% CI=36.1%, 44.4%); and 42.4% (95% CI=38.7%, 46.0%) in 2012, 2013, and 2014, respectively. Nurse practitioners/physician's assistants, physicians, nurses, and HCP working in hospitals and ambulatory care settings had higher Tdap coverage. Having contact with an infant aged ≤6 months and influenza vaccination receipt were associated with increased Tdap vaccination. Non-Hispanic black race/ethnicity, having an associate/bachelor's degree, being below poverty, non-clinical personnel status, and working in a long-term care setting were associated with decreased Tdap vaccination.

CONCLUSIONS

HCP Tdap vaccination coverage increased during 2012-2014; however, coverage remains low. Vaccination coverage varied widely by healthcare occupation, occupational setting, and sociodemographic characteristics. Evidence-based employer strategies used to increase HCP influenza vaccination, if applied to Tdap, may increase Tdap coverage.

Agreement between patients' self-report and medical records for vaccination: the PGRx database

PURPOSE

Patients' self-reported vaccine exposure (PS) may be subject to memory errors and other biases. Physicians' prescription records and other medical records (MR) do not capture noncompliance with vaccination. This study compared PS with MR for influenza, 23-valent pneumococcal, and human papillomavirus (HPV) vaccines.

METHODS

The Pharmacoepidemiologic General Research Extension (PGRx) database uses a network of over 300 general practitioners across France, who systematically recruit an age- and sex-stratified sample of patients (≥ 14 years old), without reference to their diagnoses or prescriptions. Patients received a structured telephone interview, combined with an interview guide listing vaccines commonly given. Patients' self-reported vaccination in the 3 years before their recruitment was compared with medical records kept by the physician or the patient.

RESULTS

Concordance between PS and MR was assessed for 7613 patients for whom both sources of information were available. Agreement within 3 years before the recruitment date was substantial for influenza vaccines (prevalence and bias-adjusted kappa [PABAK] = 0.74, sensitivity PS relative to MR 81.5%) and high for 23-valent pneumococcal vaccines (PABAK = 0.98, sensitivity PS 49.6) and HPV vaccines (PABAK = 0.92, sensitivity PS 91.6). In adjusted analyses, agreement varied with sociodemographic and health-related factors, particularly for influenza and 23-valent pneumococcal vaccines.

CONCLUSIONS

The PGRx method for drug exposure assessment is a new tool in pharmacoepidemiology that shows substantial to high agreement between PS and MR for exposure to various vaccines. Our finding of high agreement between PS and MR for HPV vaccination status in young women is a significant addition to the literature.

The safety of immunizing with tetanus-diphtheria-acellular pertussis vaccine (Tdap) less than 2 years following previous tetanus vaccination: Experience during a mass vaccination campaign of healthcare personnel during a respiratory illness outbreak

BACKGROUND

Tdap is recommended for health care personnel (HCP) aged <65 years who received tetanus diphtheria or tetanus toxoid immunization (Td/TT) ≥2 years earlier. During a medical center Tdap vaccination campaign, we assessed the safety of use of a Td/TT to Tdap interval <2 years in HCP. We also describe reactogenicity in HCP who were aged ≥65 years or pregnant.

METHODS

HCP vaccinated with Tdap were surveyed to assess time since last Td/TT (≥2 years vs. <2 years), age, pregnancy status, and injection site adverse events (AEs) during the 2 weeks after Tdap. AE rates were calculated and compared by non-inferiority analysis using a predetermined margin of 10%. We searched clinic logbooks to assess for clinically important adverse events during the 2 months after Tdap.

RESULTS

Of the 4524 vaccinated HCP, 2221 (49.1%) completed a safety survey which met criteria for analysis. Non-inferiority analysis found that rates of moderate and/or severe injection site AEs were not significantly greater in those vaccinated <2 years than in those vaccinated ≥2 years after previous Td/TT. Three serious adverse events were reported during the 2 months after vaccination, none in persons who were ≥65 years, pregnant or received Td/TT <2 years before.

CONCLUSIONS

Our findings add to the body of evidence that a short interval between Td/TT and a single dose of Tdap is safe.