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ACIP updates pertussis vaccination recommendations
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Health care workers should receive antimicrobial post-exposure prophylaxis to protect them against pertussis if they are exposed to someone with confirmed pertussis, even if they have been vaccinated, according to a recommendation from the Advisory Committee on Immunization Practices.
The ACIP met today in Atlanta and voted on several language changes to guidelines regarding pertussis vaccines, specifically that:
- Health care workers, regardless of age, should receive a single dose of tetanus-diphtheria-pertussis vaccine as soon as possible if they have not previously received one;
- Because Tdap is not licensed for multiple administrations after primary vaccination, health care workers should receive booster doses according to guidelines;
- Hospitals should make Tdap vaccine available to health care workers.
The ACIP also recommended in favor of post-exposure prophylaxis with antibiotics for health care workers who have had exposure to patients with confirmed pertussis, even if they have been vaccinated. This language was updated to give hospitals that option, as more health care workers become vaccinated against pertussis. The committee based its recommendations on a study of 88 participants conducted at Vanderbilt University.
Maternal vaccination
Jennifer Liang, MD, an epidemiologist in the CDC’s National Center for Immunization and Respiratory Diseases, who is involved with the committee’s pertussis working group, also discussed maternal vaccination in the second trimester as a strategy to prevent pertussis in newborns. She said there are safety data that are supportive of maternal vaccination, but there are also data that suggest there may be some interference with the diphtheria and tetanus toxoids and acellular pertussis vaccine for the infant.
Several committee members agreed with Liang that the large pertussis outbreak in California, which affected about 9,000 people in that state and 21,000 people across the country last year, highlights the importance of emphasizing vaccination to protect infants. Liang said even in the era of this pertussis outbreak, pertussis vaccination rates among health care workers remain low, with self-reported rates as low as 16%. Although the 2005 recommendations by the ACIP called for vaccination with Tdap for adolescents and adults to improve immunity against pertussis, Tdap coverage remains at about 56% among adolescents and less than 6% among adults.
Several committee members urged education so that the guidelines are followed. Liang said the revised guidelines for health care workers will be published through the CDC and in infection control recommendations. Also, committee members urged the importance of educating the public if pertussis vaccination recommendations change for pregnant women.
“Educating pregnant women about a disease that can affect her and her baby is a no-brainer,” said ACIP Committee Chair Carol J. Baker, MD.
Baker said the lack of data on Tdap vaccine use in pregnant women is a consequence of the fact that this population is typically excluded from clinical trials, and this creates a burden when trying to make recommendations on vaccine use in pregnant women.
“We need the political will somewhere to do vaccine studies in pregnant women,” she said.
Anne Schuchat, MD, NCIRD director, said the pandemic influenza and the pertussis outbreaks in California have put a spotlight on updating their educational toolkit to make families aware of the importance of vaccination. – by Colleen Zacharyczuk
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