The Tdap During Pregnancy Maintenance of Certification (MOC) is sponsored by the Indiana Immunization Coalition and has been approved by the American Board of Obstetrics and Gynecology (ABOG) for OB/GYNs throughout the country. The ABOG MOC standards now allow participation in ABOG-approved Quality Improvement Projects to meet the annual Improvement in Medical Practice (Part IV) MOC requirement. OB/GYNs who participate will maintain a daily tracking log which is submitted monthly in an effort to increase their rate of Tdap vaccine for third-trimester pregnant women by 25% during a 6-month period.
Aim of Project:
Physicians will increase their administration of Tdap vaccine to women in the third trimester of pregnancy by 25% during the 6-month project period.
Need for Project:
The United States is experiencing a resurgence of pertussis. Between 10,000 and 50,000 cases of pertussis are reported each year from all states.
Pertussis can cause serious and sometimes life-threatening complications in infants, especially within the first 6 months of life. In infants under one year of age who get pertussis, about half are hospitalized. Of those infants who are hospitalized with pertussis, about 67% will experience apnea, 23% will develop pneumonia, and 1.6% will die. Most pertussis deaths are infants who are too young to be protected by the childhood pertussis vaccine that is advised at two months of age.
In 2012, the Advisory Committee on Immunization Practices (ACIP) voted to recommend that medical providers administer a dose of Tdap during each woman’s pregnancy irrespective of the patient’s prior history of receiving Tdap (or Td). This strategy helps protect the mother from getting and passing pertussis to her infant, and also provides passive immunity to the infant. It’s expected that vaccinating your patients with Tdap during pregnancy rather than postpartum will prevent more infant hospitalizations and deaths from pertussis.
To maximize the maternal antibody response and passive antibody transfer to the infant, optimal timing for Tdap administration is between 27 and 36 weeks gestation. The level of pertussis antibodies is highest two weeks after it is given, and antibodies wane quickly. Therefore; Tdap should be administered during every pregnancy in order to transfer the greatest number of protective antibodies to each infant.
Participants in the MOC project will receive best-practice immunization guidelines that will provide further background information on this topic that can be shared with patients and families.
Requirements for Meaningful Physician Participation:
Physicians will meet or talk with the Project Leader at the onset of participation (month 1). Specific project activities and a timeline will be presented at this time. Physicians will agree to track daily the number of pregnant women (third trimester) who are eligible to receive the vaccine along with the number who actually receive the vaccine. Physicians will submit the daily tracking log on a monthly basis to the Project Leader. Emails, phone calls, or meetings as needed will occur throughout the project between the Physician and Project leader to discuss progress or barriers. At the end of the 6-month project, and when all project requirements are met, the Project Leader will report completion to ABOG.
Patient Population for Project:
Patients who are “eligible” for this project are females in their third trimester of pregnancy who visit the office during the 6-month period. While this project focuses on vaccinating women in their third trimester, it is also important to recommend the Tdap vaccine to all family members who will be in close contact with the newborn. This will “cocoon” the baby, and provide the greatest protection against pertussis.