AAP, CDC publish new Tdap vaccine recommendations

The American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC) have amended and expanded their recommendations for the use of tetanus toxoid, reduced-content diphtheria toxoid, and acellular pertussis vaccine (Tdap), according to a policy statement published online September 26 in Pediatrics.

Following a review of accumulating published and unpublished data on Tdap immunogenicity and safety, the Advisory Committee on Immunization Practices of the CDC addressed the use of Tdap in those who have not received it previously:

There is no minimum interval required or advised between receipt of a tetanus toxoid– or diphtheria toxoid–containing vaccine and Tdap when Tdap is otherwise indicated.

“Accumulating data demonstrate no increased risk of severe local reactions or serious adverse events for adolescents or adults who receive Tdap at short intervals after tetanus toxoid– or diphtheria toxoid–containing vaccines,” the policy states. However, they note that data do not exclude a significant but rare event.

A single dose of Tdap should be given to children aged 7 through 10 years who have incomplete or unknown pertussis vaccine history. Additional vaccines may be required on the basis of a catch-up schedule.

Children aged 7 through 10 years who receive Tdap should be given a booster dose of Td 10 years after their last dose of Td-containing vaccine (Tdap or Td). They should not receive the adolescent Tdap dose at the 11- through 12-year visit. “Only 1 dose of Tdap is recommended at this time, because Tdap vaccines are not licensed for multiple doses,” the policy notes.

A single dose of Tdap should be given to adults of any age (including those aged 65 years or older) who have not received Tdap previously, who are healthcare personnel, or who have or anticipate having close contact with an infant younger than 12 months, such as grandparents and other caregivers.

“The objective for vaccinating adults aged 65 years and older is to protect them from pertussis and to improve the cocooning of young infants who are too young to be protected by the DTaP series and who are at substantial risk of severe disease,” the policy noted. The vaccine is not recommended for all people age 65 and older; however, should a person in the age group want to be immunized, there are no contraindications to doing so.

A single dose of Tdap may be given in place of Td to any person aged 65 years or older who has not received Tdap previously.

The recommended age for Tdap has been extended to those aged 65 years and older who have or are likely to have contact with an infant younger than 12 months.

This policy will be incorporated into the 2012 Red Book.