ACIP Updates Guidelines for Use of Tdap Vaccine

From Medscape Medical News

Laurie Barclay, MD

January 14, 2011 — Vaccination with tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine is the best way for adolescents and adults to protect themselves and others against pertussis, according to updated recommendations for use of Tdap from the Advisory Committee on Immunization Practices (ACIP), published in the January 14 issue of Morbidity and Mortality Weekly Report.

Tdap vaccine for adults and DTaP vaccine for infants

A 1-time dose of Tdap vaccine is recommended for all adolescents and adults to boost their immunity to pertussis. In 2009, there were 16,858 pertussis cases and 12 infant deaths reported to the US Centers for Disease Control and Prevention. The report of the updated guidelines also summarizes safety and efficacy data reviewed by the ACIP and offers guidance for implementing the recommendations.

"Despite sustained high coverage for childhood pertussis vaccination, pertussis remains poorly controlled in the United States," the guidelines authors write. "Although 2005 recommendations by the ...ACIP called for vaccination with ...Tdap for adolescents and adults to improve immunity against pertussis, Tdap coverage is 56% among adolescents and <6% among adults. In October 2010, ACIP recommended expanded use of Tdap."

In the United States, 2 Tdap vaccines are available: Boostrix (GlaxoSmithKline Biologicals, Rixensart, Belgium) licensed for use in persons aged 10 through 64 years old, and Adacel (Sanofi Pasteur, Toronto, Canada) licensed for use in persons aged 11 through 64 years.

Specific recommendations in the updated guidelines include the following:

* A single dose of Tdap should be given routinely to adults aged 19 through 64 years and also to adolescents aged 11 through 18 years who completed the recommended childhood diphtheria and tetanus toxoids and pertussis/diphtheria and tetanus toxoids and acellular pertussis (DTP/DTaP) vaccination series.
* Tdap should preferably be given to adolescents at their 11- to 12-year-old preventive healthcare visit.
* Tdap can be given regardless of the time elapsed since the last vaccine containing tetanus toxoid or diphtheria toxoid.
* Tdap should be given to adults 65 years or older who are or who anticipate being in close contact with an infant younger than 12 months. A single dose of Tdap may also be given to other adults 65 years or older.
* A single dose of Tdap should be given to children aged 7 through 10 years who are not fully vaccinated against pertussis (5 doses of DTaP or 4 doses of DTaP if the fourth dose was given on or after the fourth birthday), provided they have no contraindication to pertussis vaccine.
* Children aged 7 through 10 years who were never vaccinated against tetanus, diphtheria, or pertussis, or who have unknown vaccination status, should receive a series of 3 vaccinations containing tetanus and diphtheria toxoids, with Tdap as the first of these 3 doses.

"ACIP recommends that pertussis vaccination, when indicated, should not be delayed and that Tdap should be administered regardless of interval since the last tetanus or diphtheria toxoid-containing vaccine," the report authors write.
"ACIP concluded that while longer intervals between Td and Tdap vaccination could decrease the occurrence of local reactions, the benefits of protection against pertussis outweigh the potential risk for adverse events."

MMWR Morb Mortal Wkly Rep. 2011;60:13-15. Abstract