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Neonatal intensive care units can offer vaccines and information to parents
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Preterm infants are at increased risk for Bordetella pertussis infection, and vaccinating parents in the neonatal intensive care unit may be a convenient and cost-effective strategy to reduce disease transmission.
“If we think of the neonatal intensive care unit [NICU] as a public health arena, we have a unique opportunity to deliver vaccines to parents … which subsequently protect their infants from disease,” Shetal Shah, MD, and assistant professor of neonatal medicine at Stony Brook University School of Medicine in Stony Brook, N.Y., told Infectious Diseases in Children. “NICUs are staffed with high-level medical staff 24 hours a day and are usually freely open to parents for visitation. This combination makes it a unique intersection of medical staff and a high-risk population. It’s an ideal environment to immunize parents.”
The CDC recommends that all people in close contact with infants receive the tetanus-diphtheria-acellular pertussis (TDaP) vaccine. However, vaccination rates among close contacts of infants younger than 1 year are low, suggesting that current vaccine delivery strategies need improvement.
“Although the incidence of pertussis is increasing, most parents are not fully aware of the disease’s effect or its effects on their hospitalized infants,” Shah said.
The researchers from the Stony Brook University Medical Center NICU implemented a vaccination program between July 1, 2007, and Oct. 31, 2007, aimed at increasing TDaP vaccination rates among parents through education and improved access to the vaccine.
Data indicated that vaccination rates among the study population increased from less than 2% to 86.9%. The study population included 598 parents of children gestationally aged 23 to 42 weeks who were admitted to the NICU. The researchers were able to offer vaccine to 82.8% of the parents during their child’s stay in the NICU. The results were published in Pediatrics.
Education key
As part of the vaccination program, the researchers educated NICU staff regarding TDaP vaccine risks and benefits and the rationale behind vaccinating parents. The researchers hoped to increase awareness about the vaccine by posting signs throughout the NICU and by encouraging nurses and physicians to engage parents in bedside discussions about the vaccine.
“We demonstrated that with enough education, administration of TDaP vaccine to these parents results in a high immunization rate and is delivered to most within the first few days of their infants’ hospital stay,” Shah said.
Additionally, health care workers distributed standardized consent forms to interested parents to assess vaccine contraindications, and parents who refused the vaccines were given an open-field questionnaire to determine the reason for refusal. Fifty-five parents refused vaccination, citing general disbelief in vaccination and their child’s risk for contracting pertussis as the most common reasons for refusal. Providing more education regarding the severity of pertussis in newborns may further increase vaccination rates among parents by combating the perception of the disease as an insignificant health risk, according to the researchers.
“Implementation of a NICU–based parental vaccine program is evidence-based and highly efficient at delivering the vaccine,” Shah said. “It’s also relatively easy to initiate when integrated into a NICU model of family-centered care.”
Although overall vaccination rates improved in the study population, questions still exist regarding the economic feasibility of widespread program implementation. The main advantage of NICU–based vaccine initiatives is that no additional health care workers are needed, and cost-effective modeling has indicated that this alone reduces costs compared with other outpatient vaccination programs.
However, regional factors such as incidence of pertussis in the community, proximity of high-risk contacts, smoke exposure and availability of testing facilities can affect cost savings, according to the researchers. “Additional multicenter trials are required to determine whether this vaccination rate is reproducible in other NICUs and sustainable for periods greater than the four-month trial period,” the researchers wrote. – by Nicole Blazek
For more information:
- Dylag AM, Shah SI. Administration of tetanus, diphtheria and acellular pertussis vaccine to parents of high-risk infants in the neonatal intensive care unit. Pediatrics. 2008;doi:10.1542/peds.2008-0813.