[MCOH-EH] Updated Pertussis Vaccination (Cockrum, MD David S)

[Cockrum, MD David S]

I based my cost-benefit comment on the 2011 ACIP guidelines for immunization of HCP. See page 20 of that document.


DAVIDCOCKRUM, MD
Physician
Faith Regional Physician Services
Occupational Health
(402) 844 8300
2024 Pasewalk Avenue, Suite 2, Norfolk, NE 68701
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From: MCOH-EH [mailto:mcoh-eh-bounces+dcockrum=frhs.org at mylist.net] On Behalf Of william hyman
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Subject: Re: [MCOH-EH] Updated Pertussis Vaccination (Cockrum, MD David S)


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Cost-benefit is easy to say and hard to do and defend. How do you apply a monetary value to the benefits? If you aren't applying a monetary benefit how can you compare it to cost? Also, how much cost is worth how much benefit, noting that the party incurring the cost is not necessarily the party accruing the benefit. And if an explicit not-do-it cost-benefit decision has to be defended, what do you say? "Your health wasn't worth the X dollars."
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Date: Thu, 17 Jan 2019 16:19:12 +0000
From: "Cockrum, MD David S" <dcockrum at frhs.org<mailto:dcockrum at frhs.org>>
To: MCOH/EH <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>>
Subject: Re: [MCOH-EH] Updated Pertussis Vaccination
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Thanks Terri, Tara, and Melanie for the great responses. While I didn?t dive into the details as well as Melanie did below, the conclusion is the same. There?s no evidence to support from a cost-benefit perspective. Good to know we?re not the only ones wrestling with this!


DAVIDCOCKRUM, MD
Physician
Faith Regional Physician Services
Occupational Health
(402) 844 8300
2024 Pasewalk Avenue, Suite 2, Norfolk, NE 68701

From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net<mailto:mcoh-eh-bounces at mylist.net>] On Behalf Of Swift, Melanie D., M.D. via MCOH-EH
Sent: Thursday, January 17, 2019 10:14 AM
To: MCOH/EH <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>>
Cc: Swift, Melanie D., M.D. <Swift.Melanie at mayo.edu<mailto:Swift.Melanie at mayo.edu>>
Subject: Re: [MCOH-EH] Updated Pertussis Vaccination

This is a huge conundrum in MCOH. Vaccine-mediated immunity wanes within a decade ? as does natural immunity from infection. There is no clear serologic marker of immunity - different studies use different antibodies and different cutoff levels to assess immunity, and we know that cell-mediated immunity is an important unmeasured contributor to immunity. But the consensus is that immunity is relatively short and certainly not lifelong or career long. Yet, there is no recommendation for routine adult pertussis boosters outside of pregnancy ? even every 10 years. WHO and CDC continue to recommend only the Td every 10 years.

WHO asked a SAGE panel to study this issue and they issued a report. I forget what SAGE stands for, but suffice it to say these are the world?s experts on pertussis vaccination and immunity. From a public health standpoint, the benefit of changing the recommendation for entire populations to extend pertussis boosters throughout adulthood was minimal and did not justify the enormous resource expenditure at the national level.

Obviously for healthcare personnel, there are other issues of occupational exposure management and prevention of healthcare-facility spread. BUT ? vaccination doesn?t really change exposure management. Vaccination can potentially reduce costs and morbidity from outbreaks where the index case is the healthcare worker. There are several interesting cost-effectiveness studies on Tdap in HCW, but they raise more questions than they answer, frankly.

Right now, with CDC saying no boosters are recommended routinely for HCWs, I think facilities imposing a booster requirement would be on shaky ground.

Just my 2 cents!

Melanie

Melanie Swift, MD
Senior Associate Consultant
Assistant Professor of Medicine
Division of Preventive, Occupational, and Aerospace Medicine
Phone 507.284.2560
_______________________________
Mayo Clinic
200 First Street SW
Rochester, MN 55905

We do not require it because of the research and efficacy?  Pregnant women are to get it with every pregnancy but we consider that personal and we don?t track it or require it.

From: MCOH-EH <mcoh-eh-bounces at mylist.net<mailto:mcoh-eh-bounces at mylist.net><mailto:mcoh-eh-bounces at mylist.net<mailto:mcoh-eh-bounces at mylist.net>>> On Behalf Of Cockrum, MD David S
Sent: Thursday, January 17, 2019 10:08 AM
To: MCOH/EH <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net><mailto:mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>>>
Subject: [MCOH-EH] Updated Pertussis Vaccination

Hello-

Do any hospitals/med centers have policy on re-immunizing HCWs with Tdap sooner than the usual 10 year cycle? CDC doesn?t seem to indicate the usefulness, but our OB feels that the pertussis immunity wanes within 2 years, so we?re debating whether we need to consider a policy for re-immunizing, esp in OB and Peds.

Any evidence (literature or expert guidance) to back it up would be appreciated!

Thanks,

David
DAVID COCKRUM, MD
Physician
Faith Regional Physician Services
Occupational Health


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