Pertussis (Whooping Cough)

TMA physicians have identified pertussis as a public health concern in Texas.  Reports of pertussis cases continue to come in from throughout the state. Many physicians promote the Tdap booster in their office, as the protection against pertussis from childhood vaccination can wane after five to 10 years.

Promoting Tdap 

While the infection may be mild in adolescents and adults, the disease is highly contagious and a serious threat to infants who are too young to be vaccinated. Often family members who may not even realize they have the disease transmit the infection to these young babies.

“The only way to stop pertussis’ growth is for adults to get the Tdap vaccine,” says Donald Murphey, MD, member of TMA’s Committee on Infectious Diseases, and a TMA Be Wise — ImmunizeSM advocate. “Get the shot and shield yourself from getting sick, and maybe protect an infant from a much worse fate.”

Preventing pertussis outbreaks is a shared responsibility of physicians and a local and state public health system. TMA physicians took a step toward this goal when they successfully advocated for the passage of a law requiring the hospitals, birthing centers, physicians, or midwives who provide prenatal care to provide information on pertussis to postpartum women . This will help protect, or “cocoon,” newborns from contracting pertussis.

The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) recommends other immunization strategies as well. This includes encouraging Tdap for adults over the age of 65 as well as administering Tdap in emergency departments for wound management

Vaccine Recommendations 

The Tdap vaccine is recommended for use in adolescents and adults, who may contract pertussis as a mild infection and transmit the disease to young babies. ACIP recommends Tdap for the following groups:  

  • Children aged 7-10 who have not received the complete series of DTaP,
  • Adolescents 11-18 who have completed the recommended childhood DTaP vaccination series,
  • Adults age 19-64 in place of their regular Td booster,
  • Pregnant women in their third or late second trimester who have not previouslt received tdap booster,
  • Postpartum women who have not previously received a Tdap booster,
  • Adults age 65 and older,
  • All adolescents and adults who anticipate having close contact with an ingant less than 12 months old, preferably at least 2 weeks before beginning contact with the infant, and
  • Health care personnel

 ACIP recommends Tdap be administered regardless of interval since last tetanus or diphtheria toxoid-containing vaccine. 

Health Plan Reimbursement Policies for Tdap Vaccination 

The following chart provides information on the tdap coverage policies of major insurers as well as Medicare and Medicaid. Both tdap and Dtap are included on the new Affordable Care Act’s list of vaccines that patients can receive with no cost-sharing when the services are provided in-network. This requirement takes effect in plan years that begin on or after September 23, 2010. 

Health Plan 

Policies for Tdap Vaccination 

Aetna 

Covers Tdap vaccination in accordance with ACIP recommendations. 

 

 Cigna 

 

 Covers Tdap vaccination for: 

●Adolescents, 11-18 who have completed childhood series 

●Undervaccinated children (ages 7-10);  

●Adults (ages 19-64) 

●Adults, ages 65 and older, who may have contact with infant  

●Women, immediately post-partum 

●Pregnant women – pending, contact the health plan directly to verify coverage  

 

United Healthcare 

 

 In their commercial plans, covers Tdap vaccination for:  

● Persons age 7 and over without further restrictions or edits when administered in a physician office. This includes pregnant women. 

 

Blue Cross Blue Shield 

 

Contact health plan directly  

 

 Medicare 

 

●Tdap is not covered as a medical benefit under traditional Medicare. Medicare Part D carriers may cover preventive immunizations as a pharmacy benefit, but are not required to. 

 

 Texas Medicaid 

 

 ●The Texas Vaccines For Children Program provides vaccines for Texas Medicaid clients 0-18 years according to the recommended schedule approved by the following: ACIP; AAP; AAFP. Vaccines distributed through TVFC will not be reimbursed through Texas Medicaid. 

●The following vaccine procedure codes may be reimbursed for Texas Medicaid clients who are 0-20 years of age: Tetanus and Diphtheria - 90696,* 90698,* 90700,* 90702,* 90703, 90714,* 90715,* 90718,* 90721,* 90723. *Reminds physicians about the TVFC program. 

●Vaccines may be reimbursed through Texas Medicaid at a fee determined by HHSC when the vaccine is medically necessary. The following immunizations are identified and recommended by the ACIP as medically-necessary for clients who are 21 years of age and older (this list is not all-inclusive): 
Tetanus - 90703, 90714, 90715, 90718 

 NOTICE:  This information is provided as general guidance on reimbursement issues.  Although TMA has attempted to present materials that are accurate and useful, some material may be outdated and TMA shall not be liable to anyone for any inaccuracy, error or omission, regardless of cause, or for any damages resulting therefrom.   Certain links and attachments are maintained by third parties.  TMA has no control over this information, or the goods or services provided by such third parties.  TMA shall have no liability for any use or reliance of a user on the information provided by third parties.  

TMA Communications and Educational Materials 

TMA Handout for patients. TMA’s Be Wise — ImmunizeSM program provides vaccine resources for patients and physicians, including the handout Facts About Pertussis which explains the risks of getting pertussis, how it is spread, and the importance of vaccination. 

Continuing medical education (CME) for physicians. TMA provides a one-hour online video recording for physicians who want to learn more about promoting Tdap. Cocooning: Targeted Immunization to Prevent Severe and Fatal Pertussis in Infants highlights the cocooning strategy for preventing pertussis among newborns by administering Tdap to adult caregivers. In the video, C Mary Healy, MD, who directs a cocooning program at Houston’s Ben Taub Hospital, describes techniques and barriers to cocooning.

TMA Blogs on cocooning. TMA member C. Mary Healy, MD, Assistant Professor of Pediatrics, Infectious Diesease section at Baylor College of Medicine, reminds physicians and patients of the importance of pertussis vaccination in her blogs, "Protecting Infants from Pertussis is Critical," and " Pertussis is Spreading Through Central Texas."

Article on cocooning. Dr. Healy also is the director of Vaccinology and Maternal Immunization at the Center for Vaccine Awareness and Research. She summarizes their program in “The Cocoon Strategy,” a commentary published in Texas Medicine (August 2008).

DSHS Physician materials. Posters, brochures, a handbook, and a PowerPoint training presentation all focusing on the cocooning strategy are available at preventpertussis.com, which is part of an initiative started by DSHS.  

Additional Information 


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