May 1, 2012 Minutes

Coalitions Conference Call

Tdap Cocooning Recommendations, Efforts, and Activities

Agenda Item 1: Summary of IZCoalition Network Survey
Featured Speaker: Sharon Humiston, MD, MPH, Associate Director for Research, IAC

In March, the Immunization Action Coalition (IAC) sent surveys to all immunization coalitions in the United States and Canada for which we had confirmed contact information. Sharon announced that we had a wonderful response rate of approximately 85%: 191 coalitions responded, with 130 completing every question.
Dr. Deborah Wexler, IAC’s executive director, will present the results from the survey at the National Conference on Immunization and Health Coalitions at the end of the month.

Agenda Item 2: Update on 10th annual National Conference on Immunization and Health Coalitions
Featured Speaker: Lisa Kritz, MSW, MBA, Project Director, Chicago Area Immunization Campaign

Lisa reported that over 200 people have registered to attend the National Conference on Immunization and Health Coalitions, to be held May 23-25 in New Orleans. The agenda is available at
Topics will include: strategic planning, community engagement, reaching out to diverse populations, leadership development, immunization registries, personal exemptions and school mandates, autism research, working with volunteers, advocacy, storytelling with data, sustainability, federal healthcare reform and vaccines, successful public-private partnerships, media relationships and successful media campaigns, working with other disease organizations, membership involvement, social media training, cocooning, increasing adult immunization coverage rates, working with state health programs, coalition fundraising, development of promotional materials, successful campaigns around vaccine safety, working with healthcare providers, and more.
For more information, go to

Agenda Item 3: Preventing Pertussis in Infants: ACIP’s Tdap Cocooning Recommendations
Featured Speaker: Jennifer Liang, DVM, MPVM, Epidemiologist, Meningitis and Vaccine Preventable Diseases Branch, CDC

Please see the accompanying slide deck for more detail on all these points.
Jennifer gave an overview of pertussis disease in the United States and the evolving recommendations to prevent pertussis transmission to infants. As most deaths occur in infants age 0-2 months who are too young to be vaccinated, the focus has been on vaccinating the people around them (‘cocooning’). Fewer than 50% of infants with pertussis had a potential source identified; of identified sources, household members were the most commonly identified sources of infection.
The 2005 Tdap recommendations from ACIP focused on a strategy of vaccinating all close contacts–including parents, siblings, grandparents, child-care providers and healthcare personnel–of infants age 12 months and younger with Tdap to reduce the risk of transmission of pertussis to these infants. Pregnant women were advised to be vaccinated immediately post-partum.
Such a cocooning strategy has been successful in a number of places, but there are many challenges to vaccinating postpartum women and all their family members. Unfortunately, six years after the 2005 recommendation, cocooning is not working on a national level. In 2012, ACIP updated the Tdap cocooning recommendation to say that pregnant women who have not already received Tdap should be vaccinated preferably during the third or late second trimester (alternatively, administer Tdap immediately postpartum). Shifting the timing of the mother’s dose of Tdap to pregnancy should prevent the most infant pertussis at the least cost.
The ACIP pertussis vaccines working group on Tdap is currently reviewing data and discussing the possible need for additional Tdap doses.
For more information, check out Jennifer’s slides or email her at

Agenda Item 4: Tdap and Cocooning Activities at the American College of Obstetricians and Gynecologists
Featured Speaker: Debra Hawks, MPH, Senior Director, Practices Activities; and Anna Dean, Immunization Program Manager

Please see the accompanying slide deck for more detail on all these points.
The American College of Obstetricians and Gynecologists decided to build on the momentum of the H1N1 influenza vaccination of pregnant women to work on Tdap vaccination. The College has worked with the American Academy of Pediatrics, Every Child By Two, and CDC to promote Tdap cocooning.
In March, the College released its Committee Opinion on Tdap Vaccination During Pregnancy.
On April 30, the College mailed a package about Tdap vaccination of pregnant women to its 35,000 active members. The package included:

  • Committee Opinion on Tdap Vaccination During Pregnancy
  • Laminated Physician Script with immunization codes on the back
  • FAQs for Patients concerning Tdap Vaccination
  • FAQs for Patients concerning Vaccine Safety
  • Letter from Dr. Gerald F. Joseph Jr, MD, Vice President of Practice Activates
  • Joint Pertussis letter from ANA, AMA, AAP, PNP, AWHOON, AC-NW, AAFP, ACP and the College
  • VIS for Tdap in English
  • VIS for Tdap in Spanish
  • Flyer for the College’s Immunization webpage

The College has also started a new website just about immunization for women. Some of the package materials are available on the website.
For more information, check out Debra and Anna’s slides or email Anna at

Agenda Item 5: Cocooning Efforts in Arizona
Featured Speaker: Karin Szymanski, Project Coordinator, The Arizona Partnership for Immunization

Please see the accompanying slide deck for more detail on all these points.
The Arizona Partnership for Immunization (TAPI) began an intensive Tdap cocooning outreach campaign 2.5 years ago with help from two grants. The Arizona Department of Health Services (ADHS) provided funding for working with hospitals, and the BHHS Legacy Foundation provided funding to work with community health centers. TAPI identified partners, started a Pertussis Task Force, and developed a toolkit. The toolkit includes:

  • PowerPoint presentation for basic pertussis education
  • Offer of Dr. K. Lewis, Medical Director of ADHS, to complete grand rounds
  • Developed marketing materials –flyer and poster in English and Spanish
  • Refusal to vaccinate form
  • Pertussis video–sounds of pertussis
  • General Agenda to provide hospital
  • Flow chart-style info that offers options for adults for locating a source of Tdap vaccination
  • Pre/Post survey to be distributed during training

TAPI is currently working with ADHS to launch a child-care module linked to the state immunization registry. This will support up-to-date immunizations and reports for child-care centers to run their annual immunization data report. For this new audience, TAPI has provided materials and trainings, and created a webpage for child-care centers and workers.
Next steps will include developing relationships with other hospitals state-wide (currently, the project focuses on hospitals in Maricopa County), and outreach to ob/gyns and healthcare workers.
Visit TAPI’s website where many of these materials can be downloaded or ordered.
For more information, check out Karin’s slides or email Karin at

Agenda Item 6: IAC’s new Cocooning and Tdap Vaccination web section
Featured Speaker: Mary Quirk, BS, Consultant, IAC

Mary introduced listeners to some of the resources available on IAC’s new Cocooning and Tdap Vaccination web section.
Resources come from multiple sources, including CDC, state health departments, professional societies, and nonprofit organizations. The site features recommendations, journal articles, blogs, handouts for patients, posters, videos, PowerPoint presentations, and more.
IAC is featuring a collection of videos about pertussis and the importance of Tdap vaccination.
If you know of other resources that you think should be shared on this page, contact Mary at

Agenda Item 7: Announcements from Partners
  • Dr. J. Arenas-Chico, Coordinator, CHS/Outreach, Fort Lauderdale, FL, shared that the Broward County Health Department sponsored a Florida Public Health Association Regional Conference on immunization and hepatitis B on April 27-28.
  • Deborah Wexler, MD, Executive Director, IAC, announced the launch of a major effort to promote the new fourth edition of The Vaccine Handbook: A Practical Guide for Clinicians (“The Purple Book”; 2012, 560 pages) by Gary S. Marshall, MD. Dr. Wexler has written the foreword for the new edition and IAC will promote the handbook on an ongoing basis in its electronic publications and on IAC’s website. For more information about the handbook, visit To order a copy, visit the website of the publisher, Professional Communications, Inc., or call 800-337-9838.
  • Kathy Sebert, Tulsa Area Immunization Coalition, asked if CDC was going to be developing resources such as PSAs about Tdap vaccination of pregnant women and family members that coalitions could use. CDC’s Vicki Evans replied that she would check into this. [Result: CDC has no immediate plans to develop more cocooning resources, but suggested interested parties check out the toolkit available from the Nevada Department of Health and Human Services.]


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