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Better communication necessary to improve TDaP uptake
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ATLANTA — Health care providers may improve the uptake of the tetanus-diphtheria-acellular pertussis vaccine among adults by educating them about the vaccine; increasing awareness of the risks associated with not being vaccinated; and expanding recommendations for vaccination.
CDC researchers sought to evaluate changes in tetanus toxoid-containing vaccination (TTCV) and to measure TDaP uptake among U.S. adults after the Advisory Committee on Immunization Practices recommended replacing a single dose of tetanus and diphtheria toxoids vaccine with TDaP in 2005.
“The majority of pertussis cases occur among adolescents and adults, and part of this reason is thought to be that immunity waned from childhood pertussis vaccination,” Brady Miller, MPH, of the CDC, said at the 44th National Immunization Conference in Atlanta.
Miller reported that data from the National Health Interview Survey on TTCV and TDaP from 1999 to 2008 were used to estimate vaccination coverage in adults aged 18 years or older. National Immunization Survey data on adults and TDaP vaccination from 2007 were also included in the analysis.
Results indicated that TTCV rates in 2008 did not change significantly from those observed in 1999, according to Miller. Age appeared to be the only factor that differed from 1999.
Data also showed that health care workers were three times more likely to be vaccinated. The researchers also found that adults caring for infants had lower rates of TDaP vaccination, despite ACIP recommendations to the contrary.
“Infants are particularly at risk, especially those under age 6 months. It has been shown that infants can often acquire pertussis from household contacts, like parents, brothers and sisters and grandparents, so vaccination of adults who have contact with infants is important,” Miller said during the presentation.
Miller noted that these results derived from interviews conducted six months after the ACIP recommendations were published in Morbidity and Mortality Weekly Report. The recommendations, however, were still considered provisional at that time, Miller said.
One barrier preventing higher rates of TDaP uptake identified in 2007 was lack of doctor recommendation, Miller noted. Eighty percent of adults included in the study said they would receive TDaP if suggested by their doctors. Other study participants, however, said that they thought the risk for disease was low and that they did not require vaccination, even if recommended by a doctor.
Additionally, a portion of participants who were unvaccinated said that they needed more information about TDaP before considering vaccination.
The researchers also found that only 20% of adults had heard of TDaP, and this number was about two times higher among health care workers, according to Miller.
Miller also reported that most adults who received TTCV since 2005 were not told whether they were administered Td or TDaP, and a small portion could not recall which one they were administered.
Miller said that strategies to increase TDaP uptake include using electronic and print media to increase awareness of and information on TDaP. Health care providers should also increase recommendations of TDaP vaccine, especially in adults with infants. – by Melissa Foster
The data about the prevalence of vaccination is an excellent example of why TDaP vaccination for adults is so important. It has long been recognized that immunity to pertussis from childhood vaccination wanes. Adults are commonly a reservoir and a vector for transmitting pertussis to infants and children who are more susceptible to morbidity and mortality related to the disease.
– Eugene Shapiro, MD
Yale University School
of Medicine Yale-New Haven Hospital
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