How can hospitals shield vulnerable patients from the whooping cough resurgence?

“Whooping cough” is an old-fashioned or even silly sounding name for a very serious bacterial respiratory infection. Whether we call it whooping cough, pertussis or hundred-day cough, St. Jude Children’s Research Hospital takes Bordatella pertussis outbreaks very seriously. Our successful strategies for protecting patients and staff from infection are the subject of a recent article in the journal Vaccine.

Whooping cough? Seriously?

Whooping cough is not just an old bug that our grandparents worried about. It is one of the so-called “childhood diseases” that were brought under control in the 20^th century by vaccines. Mumps, measles, diphtheria, polio, rubella and smallpox were reduced by 99% to 100%.

Whooping cough, however, has stubbornly avoided the same fate as polio and measles. In 1934, over a quarter of a million cases were reported in the United States. While vaccinations drove it down to only 1,010 cases by 1976, it has steadily increased since 1980, peaking in 2012 at 48,277 U.S. cases.

What’s so bad about whooping cough?

While any unimmunized person can catch this highly contagious infection, infants and toddlers may actually die from it, or face serious health problems, including seizures and brain damage. Pertussis can trigger coughing severe enough to cause vomiting and rib fractures. And the “whooping” part is no joke. The constant coughing can force patients to gasp for breath, causing the telltale sound. Even healthy adults may develop complications such as pneumonia and rib fractures.

What is St. Jude doing to protect patients from pertussis?

Pertussis exposure has become a growing problem in healthcare institutions. At St. Jude, most of our patients are already at increased risk of infections. We are leading the way on how the world understands and treats childhood cancer and other life-threatening diseases, so we are simply not going to let a horse-and-buggy-era disease become resurgent in our own hospital community.

That’s why we launched a landmark initiative to improve the vaccination rate for pertussis among patient-care staff at St. Jude. This successful quality improvement program, which increased our vaccination rate by approximately 55%, will serve as a model for other hospitals. Higher vaccination rates protect our vulnerable patients and hospital staff, and they also protect family members of patients and staff.

The St. Jude Tdap Working Group

Since more vaccinations is the goal, we named our project team the Tdap Working Group after the current vaccine for pertussis. (Tdap is an acronym for “tetanus, diphtheria, acellular pertussis.”) Our 23-member team includes staff from the St. Jude Infectious Diseases and Pediatric Medicine departments as well as our Occupational Health Program.

Boosting vaccinations

The main barrier causing many people to allow their pertussis vaccines to lapse is the general confusion about who should receive what vaccine and how frequently they should get it.

Drawing on programs that increased influenza vaccination rates, we developed a communication strategy that included enhanced record-keeping to identify which staff had received the Tdap vaccine.

• Unvaccinated staff received individual emails from Occupational Health Program (OHP) supervisors and hospital leaders.
• Senior medical leaders took time to speak, in person, with staff who were unimmunized.

Other interventions included changes to OHP processes, a general education campaign and improved, after-hours access to vaccination services.

Useful lessons for other health care institutions

One important lesson for health care leaders to note: You may think you’re reaching people with information, but it may not be registering. We discovered that the experience of having somebody you know and respect drop by to chat with you about vaccination was a great incentive. St. Jude is a relatively small institution, but larger hospital groups could be similarly successful by prioritizing key hospital divisions and identifying high-profile staff working in those units to serve as ambassadors for such a program.

Read the full text of the Tdap Working Group’s published report:

"A quality improvement initiative to increase Tdap (tetanus, diphtheria, acellular pertussis) vaccination coverage among direct health care providers at a children’s hospital."  Vaccine. 2018 Jan 4;36(2):214-219.