Shot of Prevention
The Tetanus, Diphtheria, Pertussis vaccine (Tdap for short) is usually administered to pregnant women to protect their unborn offspring from pertussis – a serious respiratory infection better known as whooping cough.
But for some, just gaining access to the vaccine can pose challenges that lead to lower rates of inoculation.
When a pair of University of New Mexico medical students learned that women receiving prenatal care at three UNM Maternity & Family Planning (M&FP) clinics were being sent elsewhere for the vaccinations, they set out to look for a solution.
Amber Lalla and Katarina Leyba, now in their fourth year in the UNM School of Medicine, found that the three federally funded clinics, situated at sites around the city, lacked refrigeration and backup generators to properly store the vaccine onsite.
Women, many of whom lacked health insurance, were being referred to clinics elsewhere in Albuquerque run by the New Mexico Department of Health, where they could receive the Tdap vaccination for free.
But those clinics required a separate appointment – and it appeared many patients weren’t following up on the referral.
“Katarina and I love research,” Lalla says. They combed through the medical records of 350 pregnant women seen over a five-month period to assess the impact of requiring patients to travel to a different location for the vaccinations. A statewide database helped them determine who ended up receiving the shots.
“We saw huge difference in vaccination rates,” Lalla says. Only 31.9 percent of women receiving care at the M&FP clinics got the Tdap vaccination, versus 71.9 percent in the obstetrics clinic at UNM Hospital (UNMH), which provides onsite vaccinations.
To give their study context, they also compared the rates of inoculation with the flu vaccine, which was readily available at both UNMH and M&FP clinics. “The rates of flu vaccination were very similar,” Leyba says. “It showed having the vaccine onsite was one of the more significant factors.”
The pair also found that women at M&FP clinics are more likely to receive the vaccine at a point where it is least effective, right before or after delivery, when it can no longer move the placenta and can only be passed through breastmilk.
“This enforces the idea that by putting vaccines onsite and increasing access we can make sure women receive this vaccine when it is most effective during the recommended time frame of 27 to 36 weeks,” Lalla said.
The next step was to share the results of their Tdap research, Leyba says. “We were able to present our data at the New Mexico Immunization Coalition meeting, showing there was an objective difference in the vaccination rates."
Following the presentation last July, the Department of Health agreed to provide funding for a backup generator in one of the clinics to ensure refrigeration in the event of a power failure. The other two clinics are located at First Choice Community Healthcare sites, which agreed to store the vaccines in their own refrigerators.
“The vaccine has been in the clinics since April,” Leyba says.
The pair collaborated on the project with Jody Stonehocker, MD, residency program director in the Department of Obstetrics & Gynecology and medical director of the M&FP clinics, and Melissa Martinez, MD, professor in the Department of Internal Medicine.
Nursing unit director Jeanine Peek, RN, helped implement the new protocols, while nurse-midwife Katrina Nardini helped to create new patient education and included mention of the Tdap vaccine in the prenatal book given to each pregnant patient.