Obstetrician/gynecologist offices may be the ideal venue for boosting vaccination rates among women, say researchers at Duke University Medical Center. They have reported on a successful pilot program focused on providing HPV (human papillomavirus) and Tdap (tetanus, diphtheria, pertussis) vaccines to non-pregnant and post-partum women.
The researchers say the program, funded by the U.S. Centers for Disease Control, could be a model for ob/gyn clinics across the country to increase much-needed immunizations among eligible adults.
"Ob/gyns don't typically think of themselves as vaccinators," says Geeta Swamy, MD, Director of Obstetrics Clinical Research at Duke, who presented the findings April 19 at the CDC National Immunization Conference in Atlanta. "Even though we vaccinate pregnant women against a variety of diseases that are screened for during pregnancy, we still tend to think of vaccinations as happening at the offices of pediatricians, primary care physicians and family practitioners. But many women seek medical care from their gynecologists, even after they have children. Their annual gynecologist visit is a good opportunity to discuss preventive care which includes vaccinations."
The North Carolina pilot program was set up to improve HPV vaccination rates among non-pregnant women. Preliminary data from one clinic shows that non-pregnant women were already being offered HPV, but when post-partum women were offered the vaccine, the rate of vaccination jumped from 0 to 44 percent. "These women would not have been vaccinated if this program was not in place," Swamy said.
Even more significant was the increase in women who received the Tdap vaccine. "Nearly 600 women received the vaccine of the 1000 who were offered it," she said. None had been offered it before.
Reaching women who had not been vaccinated is important because rates of pertussis have been on the rise for the last five years despite CDC recommendations that adults and adolescents receive the newer, single dose if they had not received a tetanus shot within the past two years.
Although the disease is not as serious in adolescents and adults, it is life-threatening among infants who aren't fully immunized until at least one year of age. A recent CDC report found mothers were the primary source of infection in 32 percent of infant pertussis cases. "Ideally we aim to vaccinate women before they conceive, but any post partum woman should get the vaccine if their last tetanus shot was two years ago or more," says Swamy. "If we can vaccinate new moms, we can provide a cocooning effect that protects their infants from this deadly disease."
Swamy believes the program could easily be implemented in ob/gyn offices nationwide as more emphasis is being placed on preventive care. "We should be thinking of preventive medicine as something that's done at almost any medical encounter, and not just limiting it to the primary care field. It should be provided by all doctors where it's feasible and within the scope of their care."
Additional Duke researchers involved in this study include Evan Myers, MD, R. Phillips Heine, MD, and Emmanuel B. Walter, MD.
This program was supported by a grant from the Centers for Disease Control and Prevention.
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