VA-TETANUS/DIPHTHERIA/PERTUSSIS (TDAP) IMMUNIZATION (104)    REMINDER DEFINITION (811.9)

A single dose of Tdap (Tetanus Toxoid, Reduced Diphtheria Toxoid and 
  A history of encephalopathy (e.g., coma or prolonged seizures) 
  not attributable to an identifiable cause within 7 days of
  administration of a vaccine with pertussis components. This
  contraindication is for the pertussis components, and these persons
  should receive Td instead of Tdap.
 
PREGNANT/BREASTFEEDING WOMEN:
  Women's health care providers should implement a Tdap 
  vaccination program for pregnant women. Health care providers should 
  administer Tdap during each pregnancy, preferably during the third 
Acellular Pertussis vaccine) should be given regardless of when the last 
  trimester (between 27-36 weeks gestation), although Tdap may be given at
  any time during pregnancy. If Tdap is not administered during pregnancy,
  Tdap should be administered immediately postpartum.
  The rationale for repeat vaccination during each pregnancy is 
  that reported cases of pertussis continue to increase, uptake of Tdap 
  vaccine among pregnant women remains low and new data indicate that 
  maternal anti-pertussis antibodies are short-lived, thus Tdap
  vaccination in one pregnancy will not provide high levels of antibodies
  to protect newborns during subsequent pregnancies. The rationale for
  administration during the third trimester (between 27-36 weeks
Tetanus containing product was received in adults who have not previously 
  gestation) is that this would provide the highest concentration of
  maternal antibodies to be transferred closer to birth, but also allow
  for the 2 weeks (before birth) required to mount a maximal immune
  response to the vaccine antigens.
received Tdap.  In addition, pregnant women should receive an additional 
dose during each pregnancy.
 
TdaP Contraindications:
  A history of serious allergic reaction (i.e., anaphylaxis) to any 
  component of the vaccine.

**Since Tdap was NOT available before 2005 and was NOT given at this 
have been in use at a VAMC to indicate the following items:
  Tdap Immunization Refusal
  Acute Febrile Illness
Any finding in this Reminder Term will resolve the reminder for
predetermined amount of time.  
 
The Reminder Term, "VA-TDAP CONTRAINDICATION", contains 
Computed Findings looking for allergies to TETANUS, DIPHTHERIA or 
PERTUSSIS that have been documented in the Allergy/Adverse Drug Reaction
package. If found, the reminder will not apply - AND NOT Cohort Logic.
facility prior to 2006, any record of Tdap prior to these dates will be 
Health Factors in use locally to document allergy to Td should also be
included in this Reminder Term.
   
Reminder Term, "VA-TDAP ORDER" should contain any orders for the Tdap 
vaccine.  Sites should map any orders that are used for the Tdap 
vaccine.  The reminder will be resolved for 28 days by the order for TdaP
vaccine.  
   
COHORT:
-Not applicable for patients with a Tdap Contraindication
ignored and assumed to be an incorrect entry.
 
RESOLUTION:
-Tdap Immunization
-Tdap Deferrals
-Tdap Orders
 
Reminder Term, "VA-TDAP IMMUNIZATION" includes the standardized
immunization for Tdap.  Sites should also include any locally 
created immunizations that were used for Tdap vaccines.
 
Reminder Term "VA-TDAP DEFERRALS" should include any Health Factors that

• REMINDER FREQUENCY:   99Y
  MINIMUM AGE:   19
  AGE MATCH TEXT:   

  Tdap due once for patients 19 and over.
  

  NO. OF AGE MATCH LINES:   1
  NO. OF AGE NO MATCH LINES:   0