Adult Immunization 2010

Tetanus, Diphtheria and Pertussis Segment

This material is in the public domainThis information is valid as of May 25, 2010

NOTE:Participants are strongly encourage to have a copy of the current adult immunization schedule available during this program.

The current schedule can be downloaded from the CDC Vaccines and Immunizations website athttp://www.cdc.gov/vaccines/recs/schedules/adult-schedule.htm

Tetanus and Diphtheria Immunity

• More than 50% of adults 20 years of age and older in the U.S. do not have a protective level of antibody against tetanus and diphtheria

• Many adults 60 years of age and older have not received a primary series of tetanus- and diphtheria-containing vaccine

• Many adults of all ages do not receive routine Td booster doses every 10 years

Reported Pertussis by Age Group, 1990-2008

0

5000

10000

15000

20000

25000

30000

1990 1995 2000 2005

Year

Cas

es

<11 11-18 >18

Tetanus and DiphtheriaVaccines for Adults

• Tetanus and Diphtheria Toxoid (Td)

–formalin-inactivated toxins

–3 doses induces protective antibody in nearly everyone

–protection for at least 10 years

• Tdap

Tdap Vaccines

• Boostrix (GlaxoSmithKline)

–single dose

–approved for persons 10 through 64 years of age

• Adacel (sanofi pasteur)

–single dose

–approved for persons 11 through 64 years of age

General Principles for Useof Tdap and Td

• No brand preference

• Tdap preferred to Td to provide protection against pertussis

• Approved as a single booster dose in persons who have previously received a full series of pediatric DTaP or DTP

Persons Without Documentation of Pertussis Vaccination

• All adults should have documentation of having received a series of DTaP, DTP, DT, or adult Td

• Adults without documentation should receive or complete a series of 3 doses

• Preferred schedule*:

–single dose of Tdap

–Td at least 4 weeks after the Tdap dose

–second dose of Td at least 6 months after the Td dose

*off-label recommendation. See MMWR 2006;55(RR-17)

Minimum Interval BetweenTd and Tdap

• ACIP did not define an absolute minimum interval between Td and Tdap

• Provider will need to decide based on whether the benefit of pertussis immunity outweighs the risk of a local adverse reaction

MMWR 2006;55(RR-17)

Tdap and Pregnancy

• Td is generally preferred during pregnancy• All women should receive a dose of Tdap in

the immediate postpartum period• Any woman who might become pregnant is

encouraged to receive a single dose of Tdap• A clinician may choose to administer Tdap to

a pregnant woman in certain circumstances, such as during an outbreak of pertussis in the community

• Pregnancy is not a contraindication to vaccination with Tdap

MMWR 2008;57(RR-4)

Tdap and HealthcarePersonnel (HCP)

• Healthcare personnel who work in hospitals or ambulatory care settings and have direct patient contact should receive a single dose of Tdap as soon as feasible

• Priority should be given to vaccination of healthcare personnel who have direct contact with infants 12 months of age and younger

• Other HCP should receive a single dose of Tdap to replace the next scheduled Td

MMWR 2006;55(RR-17)

Tdap Contraindications

• Severe allergic reaction to a vaccine component or following a prior dose

• Encephalopathy within 7 days of administration of a pertussis vaccine that is not attributable to another identifiable cause

Tdap Precautions

• History of an Arthus-type reaction following a previous dose of tetanus or diphtheria toxoid-containing vaccine

• Progressive neurologic disorder, uncontrolled epilepsy, or progressive encephalopathy until condition stabilized

• History of Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of tetanus toxoid-containing vaccine

• Moderate or severe acute illness

Tdap/Td Adverse Reactions

• Pain 66% - 75%

• Redness 23% - 24%

• Swelling 21%

• Temperature 3% - 5%(100°F or higher)

• Systemic 30% - 40%

National Center for Immunization and Respiratory Diseases

Contact Information

• Telephone (800) CDC-INFO

• Email nipinfo@cdc.gov

• Websitehttp:///www.cdc.gov/vaccines/

• Broadcast Updates and Resources

Web Page

www.cdc.gov/vaccines/ed/webcasts.htm