24th October 2012

Temporary programme of pertussis (whooping cough) vaccination of pregnant and newly delivered women commencing 15th October 2012

Borders implementation plan

Background

  • National outbreak of pertussis since mid-2011, largest seen in UK for over a decade
  • 1037 confirmed cases in Scotland, 65 of which were in infants <3 months of age (at end Sep 2012)
  • Highest mortality and risk of serious complications is in infants <3 months who are too young to be protected through routine childhood immunisation
  • CMO letter dated 28th September 2012 outlined the introduction of a temporary programme of pertussis immunisation of pregnant women following recommendation by the Joint Committee on Vaccination and Immunisation (JCVI)
  • Pertussis vaccination should be provided to

-all pregnant women who are at or are over 28 weeks gestation (optimal time 28-32 weeks gestation)

-all newly delivered women up to when their infant commences routine childhood immunisations, only if they have not been previously immunised against pertussis

  • The purpose of the vaccinating pregnant women is to transfer pertussis-specific antibodies from mother to baby to protect the infant in the period before routine immunisation starts at 8 weeks of age. The purpose of vaccinating newly delivered mothers is to protect the mother from pertussis, providing indirect protection to the infant during the vulnerable period prior to routine immunisation

Implementation of vaccination programme in Borders

The roles, responsibilities and key actions of NHS Borders staff and participating GP practices are outlined below.

Roles and responsibilities

1. Midwifery services

Midwives will

-provide counselling for pertussis immunisation, an invitation letter (Appendix 1) and an information leaflet to pregnant women attending antenatal appointments and, where appropriate, to women in the post-natal period

-advise women to attend their GP practice for pertussis immunisation

-fill out the first part of the pertussis vaccination data collection form (Appendix 2) and send this to the patient’s GP to ensure that GPs are notified of vaccine eligible pregnant women

-record counselling and referral given in the Scottish Women Held maternity Record (SWHMR)

There will be a vaccination catch up programme in addition to an ongoing programme.

Vaccination catch up: Midwives will contact all women who are at or over 34 weeks gestation and follow the actions outlined above.

Ongoing vaccination programme for women entering the pregnancy cohort: Midwives will follow the actions outlined above for all women attending the 28 week routine antenatal appointment and will raise pertussis vaccination at all subsequent routine antenatal appointments after 28 weeks.

2. General Practices

General Practices will

-be responsible for establishing a system within practices for immunising pregnant and newly delivered womenagainst pertussis enabling staff to access online training provided by NHS Education for Scotland (NES) in line with the DES (No.2) Directions 2012 dated 28th Sep 2012

-receive notification of vaccine eligible women from midwives through receipt of a pre-populated pertussis vaccination data collection form, specifying the woman’s contact details, pregnancy and vaccination status

-record the vaccination and date given using the READ code ‘65I8’ Low dose dipth, tet, acellular pert inactive polio vaccine (note that is a capital letter ‘I’ before the 8) in EMIS

-complete the final section of the data collection form (Appendix 2) recording the vaccine and date given or enter vaccination details into EMIS using EMIS template provided

-record the vaccination given in the Scottish Women Held maternity Record (SWHMR)

PSD are in the process of developing a claim form which can be used by practices at the end of the year to claim payments for vaccinations administered. Pharmacy orders should be made to BGH pharmacy as per normal procedure. If practice managers wish to use an alternative system to vaccinate women, a list of vaccine eligible women can be obtained from their local midwife.

3. Public Health

Public Health will coordinate the programme and arrange updates and feedback to stakeholders as appropriate. Public Health will also work with Pharmacy staff to ensure an uptodate PGD is available to all immunisers (available on NHS Borders intranet at: under ‘Repevax for pregnant and newly delivered women’).

4. BGH Pharmacy

Pharmacy will ensure adequate supplies of pertussis vaccination (Repevax) to GPs

Appendix 1. Letter to invite pregnant/newly delivered women to get a pertussis vaccination

Dear <patient's name>

There is a lot of whooping cough (pertussis) around at the moment in Scotland andnewborn babies who are too young to start their vaccinations are at greatest risk of serious disease.

You can help protect your unborn baby from getting whooping cough in its first weeks after birth by having the whooping cough vaccination while you are pregnant. You should have the vaccination even if you’ve been vaccinated before or have had whooping cough yourself.

The whooping cough vaccine has an excellent safety record and there is no evidence of harm from having the vaccine whilst you are pregnant. It’s much safer for you to have the vaccine than to risk your newborn baby catching whooping cough. Please note that the whooping cough vaccine is only available as a combined vaccination that also protects against diphtheria, tetanus and polio, as well as whooping cough.

Remember, whooping cough is a serious disease that can lead to pneumonia and permanent brain damage, as well as death.

The best time to get vaccinated to protect your baby is as soon as possible from week 28 of your pregnancy, but the vaccine can still be given up until the time you deliver. You may also be offered the vaccine if you have recently given birth. You can receive the vaccination up until your child receives their first routine childhood vaccination at 8 weeks old, but this is only needed if you have never been vaccinated against whooping cough before. The vaccine is not available before week 28 of your pregnancy because it will not provide sufficient protection for your baby if given at that time.

Please make an appointment with your GP practice to receive the vaccine.

If you have not already had the influenza vaccine you will be offered both whooping cough vaccine and influenza vaccine at this appointment.

Please accept our apology if you have already received this letter from another source or if the circumstances of your pregnancy have changed.

Enclosed is an information leaflet entitled ‘Whooping Cough – help protect your baby’. Further information is available from your midwife or GP and also at the link below.

Remember, young babies cannot be vaccinated, so act now to protect your baby

Yours sincerely,

Dr Tim Patterson, Immunisation Coordinator


Elaine Cockburn, Head of Midwifery

Dr Jonathan Kirk, Associate Medical Director, Primary and Community Services

Appendix 2: Data recording form

Patient details
Name:......

CHI:

Address:...... Post Code -
GP Name:......
Surgery Address:......
Midwife:......
Pregnancy Status
LMP:...... Gestational Age weeks
Expected date of delivery - -
Number of previous pregnancies (ending in live/stillbirth)
Delivery Status
Delivery date
Date of last pertussis containing vaccine: /
/ None / N/K
Contraindications or Refusal
Contraindications:
A confirmed anaphylactic reaction to a previous dose of diphtheria, tetanus, pertussis or poliomyelitis containing vaccine
A confirmed anaphylactic reaction to any component of the vaccine
Refusal:...... Date refused
Vaccine Given
Name:......
Vaccine:...... Batch:...... Date of vaccine
Site: Arm Right Left
Vaccinator
Name:...... Title:......
Professional Registration Number:...... Claim Fee: Yes No