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St. Jude initiative boosts whooping cough vaccination rate

Quality improvement effort shows the way to enhance vaccination among health care providers and protect patients.

Memphis, Tennessee, January 10, 2018

Elisabeth Adderson, M.D., an associate member of the Department of Infectious Diseases

Elisabeth Adderson, M.D., an associate member of the Department of Infectious Diseases

A St. Jude Children’s Research Hospital quality improvement initiative has significantly increased the vaccination rate for pertussis, or whooping cough, among its patient-care staff. The 90 percent vaccination rate not only better protects patients, family members and coworkers, said the initiative’s leaders, it also offers a model for other health care institutions.

The team, which included Elisabeth Adderson, M.D., an associate member of the Department of Infectious Diseases, published a report on their initiative in the scientific journal Vaccine.

Before the initiative, about 58 percent of St. Jude health care workers with patient contact had received the Tdap (tetanus, diphtheria, acellular pertussis) vaccine, Adderson said. While this percentage is about double the national average for health care workers, Adderson and her colleagues believed that a major communication campaign could greatly increase that number.

The St. Jude clinicians were motivated by the fact that pertussis exposure has become a significant problem for hospitals. “Since the 1980s, there has been a major increase in the incidence of pertussis in communities,” Adderson said. “This means providers and patients bring it into health care facilities. So, widespread vaccination is absolutely necessary to prevent its spread. We are, of course, very committed to keeping our patients safe. Most of our patients are at increased risk of infections, so we are highly sensitive about exposing them to any kind of risk.

“What’s more, not only can pertussis outbreaks cause serious illness among providers and patients; they can increase absenteeism and health care costs for diagnosis and treatment,” Adderson said. “Studies have shown that vaccinations are incredibly cost effective, returning between two and four times their investment.”

The St. Jude Tdap initiative aimed at emphasizing the seriousness of pertussis as an illness and educating staff about the vaccine. “There seems to have been a fair bit of confusion about who should get what vaccine and how frequently they should get it; and that has resulted in people not necessarily getting the vaccinations they should,” she said.

Besides the Department of Infectious Diseases, the Tdap Working Group included staff from the Occupational Health Program and the Department of Pediatrics, among other St. Jude medical services.

Drawing on programs aimed at increasing influenza vaccination, the working group developed a communication strategy that included enhanced record-keeping to identify which staff had received the Tdap vaccine. The group launched a hospital-wide educational campaign that included features on the electronic bulletin boards of “Bug of the Month—Pertussis,” and “Drug of the Month—Tdap Vaccine.” The group also gave presentations about the vaccine at hospital clinical conferences.

As part of the initiative, the hospital made the vaccine more available to nurses and shift workers who could not make appointments during business hours. Unvaccinated staff also received personal emails from Occupational Health Program supervisors as well as hospital leaders. Particularly effective, Adderson said, were in-person communications to encourage vaccination.

“It is a tremendous testimonial to how dedicated people in our institution are to the health of their coworkers and our patients that these busy senior medical leaders took time to talk to people who were unimmunized,” Adderson said. “They explained about the benefits of the pertussis vaccine and the risks of not being vaccinated.

“We found that having somebody you know and respect in your department coming to talk to you about vaccination was an effective incentive for people,” she said.

As a result of the campaign, the St. Jude Tdap vaccination rate reached its goal of 90 percent. The achievement offers useful lessons for other health care institutions. “One important lesson is that you may think you’re reaching people with information, but it may not be registering,” Adderson said. “So, individualizing the information and having personal contact is particularly important.”

Applying the vaccination strategy to larger institutions would be more complicated, Adderson said. “We are a relatively small institution, so we have the advantage that the people in our working group are well known to others in the hospital However, larger institutions could be successful by identifying smaller units within the institution, and people within those units who can be champions for the program.”

The group is expanding the St. Jude Tdap vaccination initiative to include staff who work in a building where patients receive care. The team is also conducting surveys to understand how better to motivate people to be vaccinated and to enhance their understanding of the benefits.

Other co-authors of the Vaccine paper were Tdap Working Group representatives Changhong Jiang, LaQuita Whitmore-Sisco and Aditya Gaur, all of St. Jude. The 23-member Tdap Working Group included Patrick Campbell, Matthew Ehrhardt, Daniel Green, Patricia Flynn, Diego Hijano, Melissa Hudson, Seth Karol, Katherine Knapp, Monika Metzger, R. Ray Morrison, Sheena Mukkada, Alberto Pappo, Raul Ribeiro, Giles Robinson, Jeff Rohman and Jeffrey Rubnitz, all of St. Jude; and Kenice Ferguson-Paul, Nicholas Hysmith and Wing Leung, all formerly of St. Jude.

The project was supported by ALSAC, the fundraising and awareness organization of St. Jude.

St. Jude Children's Research Hospital

St. Jude Children's Research Hospital is leading the way the world understands, treats and cures childhood cancer and other life-threatening diseases. It is the only National Cancer Institute-designated Comprehensive Cancer Center devoted solely to children. Treatments developed at St. Jude have helped push the overall childhood cancer survival rate from 20% to 80% since the hospital opened more than 50 years ago. St. Jude shares the discoveries it makes, and every child saved at St. Jude means doctors and scientists worldwide can use that knowledge to save thousands more children. To learn more, visit or follow St. Jude on social media at @stjuderesearch.