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ACIP proposed updates to pertussis vaccination recommendations

Children who receive Tdap between ages 7 and 10 years should be considered up-to-date for school entry requirements.

In light of the ongoing pertussis outbreak in California that led to dramatic increases of patients younger than the age of 6 months admitted to the Children’s Hospital of Orange County, the Advisory Committee on Immunization Practices proposed updates to the routine pertussis vaccination schedule in adults aged 65 years and older and in children between 7 and 10 years.

In a unanimous vote, the committee recommends the following two parts be updated to the recommendation of Tdap in adults 65 years and older:

• Recommendation for the purposes of cocooning: adults aged 65 years and older who have or anticipate having a close contact with infants aged younger than 1 year (such as grandparents and health care providers) should receive a single dose of Tdap to protect against pertussis and reduce the likelihood of transmission in infants less than 12 months.
• Wording to be: for adults aged 65 years and older, a single dose of Tdap vaccine may be given in place of a tetanus and diphtherias toxoid vaccine in those who have not received Tdap.

Proposed changes to the recommended use of Tdap in children aged between 7 and 10 years include:

• Children aged 7 to 10 years who are not fully immunized against pertussis and for whom no contraindication for pertussis vaccine exists should receive a single dose of Tdap to provide protection against pertussis.
• If additional doses of tetanus and diphtheria toxoids are needed than children aged 7 to 10 years should be vaccinated according to catch-up guidance. Further guidance will be forthcoming on timing of re-vaccination in persons who have received Tdap prior to age 11 years.

• Children aged 7 to 10 years who have never been vaccinated against tetanus, diphtheria or pertussis or who have unknown vaccination status should receive a series of three vaccinations containing tetanus and diphtheria toxoids. The preferred schedule is a single dose of Tdap followed by a dose of TD more than 4 weeks after Tdap and then followed by another dose of TD 6 to 12 months later. If not administered as the first dose, Tdap can be substituted for any other TD doses in the series.

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