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AAP updates Tdap recommendations
AAP Committee on Infectious Diseases. Pediatrics. 2011;doi:10.1542/peds.2011-1752.
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The American Academy of Pediatrics’ Committee on Infectious Diseases issued a statement that eliminated minimal intervals between receiving tetanus or diphtheria toxoid vaccines and receiving the tetanus, reduced diphtheria and reduced-content pertussis vaccine, as well as other recommendations on the vaccine for adolescents and adults.
These changes are in line with the CDC’s Advisory Committee on Immunization Practices vote from October of last year.
The AAP’s committee members said the minimal interval recommendation followed data showing no reactogenicity after a shorter duration between doses.
Before the ACIP vote, there was no recommendation for pertussis immunization for a child aged 7 to 10 years because none of the available pertussis-containing vaccines was licensed for this age group.
However, because the safety data backed Tdap and the expectation that the vaccine will be immunogenic in this age group, ACIP recommended off-label use of Tdap for these children to protect them against pertussis infection and disease. Children aged 7 to 10 years who are not fully immunized against pertussis and for whom no contraindication to pertussis vaccine exists should receive a single dose of Tdap to provide protection against pertussis.
ACIP also recommended last year that adults aged 65 years and older who have or who anticipate having close contact with an infant aged younger than 12 months (eg, grandparents, childcare providers and health care practitioners) and who have not previously received Tdap should receive a single dose of Tdap to protect against pertussis and reduce the likelihood of transmission of pertussis to these vulnerable infants, and the AAP statement backs this guidance.
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Pertussis remains a serious threat to young infants. Widespread circulation of Bordetella pertussis continues in the United States in spite of the introduction of tetanus toxoid, reduced-content diphtheria toxoid, and acellular pertussis vaccine (Tdap) in 2005. So far, the number of adolescents and adults who have received a single dose of Tdap vaccine has been inadequate to change the current epidemiology of B. pertussis. More than 16,000 cases of pertussis and 12 infant deaths were reported to the CDC in 2009. Last year in California, more cases of pertussis were reported than in each of the past 60 years, and 10 infants died.
This AAP Committee on Infectious Diseases policy statement updates the AAP's recommendations for the use of Tdap. These recommendations were developed in conjunction with the CDC's Advisory Committee on Immunization Practices. The AAP policy statement includes three major changes, which are designed to expand Tdap coverage, improve immunization rates and protect infants by reducing pertussis activity in the United States.
Safety data is now available to allow the recommendation to give Tdap regardless of the interval from administration of the prior tetanus- or diphtheria-containing vaccine. The second recommendation is important to provide protection for children 7 through 10 years of age who have not received a complete series of DTaP immunizations. Tdap is now recommended for these children, rather than waiting until their 11th birthday. Lastly, to improve protection of infants, the age recommendation for a single dose of Tdap has been extended to include all adults 65 years of age and older who have or are likely to have contact with an infant aged younger than 12 months.
These new recommendations should be adopted as soon as possible to protect infants against this serious life-threatening vaccine-preventable disease. The most recent CDC survey data indicates that only 56% of adolescents aged 11 through 18 years and fewer than 6% of adults have received Tdap. We need to do better.
Joseph A. Bocchini, Jr., MD
Infectious
Diseases in Children Editorial Board member
Disclosure: Dr. Bocchini reports no relevant financial disclosures.
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