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CDC Recommendations for Use of Tdap Are Now Simpler! Everyone Age 11 and Older Needs a Dose

August 2012

Technically Speaking
Monthly Column by Deborah Wexler, MD
Deborah Wexler MD
Technically Speaking is a monthly column written by IAC’s Executive Director Deborah Wexler, MD. The column is featured in The Children’s Hospital of Philadelphia Vaccine Education Center’s (VEC’s) monthly e-newsletter for healthcare professionals. Technically Speaking columns cover practical topics in immunization delivery such as needle length, vaccine administration, cold chain, and immunization schedules.
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TECHNICALLY SPEAKING
CDC Recommendations for Use of Tdap Are Now Simpler! Everyone Age 11 and Older Needs a Dose
Published August 2012
Information presented in this article may have changed since the original publication date. For the most current immunization recommendations from the Advisory Committee on Immunization Practices, visit www.immunize.org/acip/acip_vax.asp.
With pertussis widely circulating throughout the nation and infant hospitalizations and deaths escalating, the Centers for Disease Control and Prevention (CDC) has further expanded its recommendations for the use of Tdap vaccine. In June CDC published its latest Tdap recommendations, which added adults age 65 years and older to the list of people who should be vaccinated against pertussis. This means that every person in the U.S. age 11 years and older now is recommended to receive a one-time dose of Tdap vaccine the next time they see their healthcare provider (i.e., not waiting 10 years or until their next Td is due). Furthermore, CDC advises administering Tdap regardless of the interval since the person last received Td.
As seen in the timeline below, CDC has gradually expanded Tdap recommendations so that they now cover every adolescent and adult in the U.S.
•
March 2006— All adolescents 11–19 should receive a routine dose of Tdap (instead of Td).
• December 2006 —
•
Adults 19–64 in need of a Td booster should receive a one-time Tdap dose instead of Td.
• Adults in close contact with an infant should be vaccinated with Tdap regardless of the interval since their last Td dose.
• Adults who need wound prophylaxis for tetanus should receive Tdap instead of Td if they have not already received a dose of Tdap.
• Healthcare personnel who have direct patient contact should receive a single dose of Tdap as soon as feasible.
• May 2008 — Pregnant women should receive Tdap immediately post-partum if they did not receive it prior to pregnancy.
• January 2011 —
•
Adults age 65 years and older who have or anticipate having close contact with an infant younger than age 12 months should receive a dose of Tdap.
• Undervaccinated children age 7 through 10 years should receive a dose of Tdap as part of their catch-up schedule.
• Tdap should be administered to patients regardless of interval since they last received a dose of Td vaccine.
• October 2011 — Pregnant women who have not already received a Tdap dose should receive one during pregnancy, preferably during the third or late second trimester (after 20 weeks’ gestation).
• June 2012 — All adults age 19 years and older, including those age 65 and older, who have not yet received a dose of Tdap, should receive a single dose now.
The recommendations have been challenging to stay up to date with, but now they’ve evolved into something quite simple to follow.
CDC recommends a single Tdap dose for all people age 11 years and older who have not previously received it. This includes pregnant women who are at 20 weeks or more gestation, as well as adults age 65 years and older.
Here are a few additional recommendations from CDC:
1.
People who anticipate being in contact with an infant should be vaccinated at least 2 weeks ahead of time.
2. Providers may administer either of the Tdap vaccines they have available in their offices. When feasible, Boostrix® (GSK) should be used for adults age 65 years and older because it is licensed for this age group; however, CDC says either Tdap product (Adacel® [sanofi], or Boostrix) may be used; both are immunogenic and would provide protection. A dose of either should be considered valid.
3. Currently, only one dose of Tdap is recommended. Thereafter, resume giving a Td booster every 10 years.
3. If you cannot verify whether a patient has ever received a dose of Tdap, CDC recommends administering a dose of Tdap.

 

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