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Advisory No. 17. Tdap Vaccine Recommendations Update

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Immunization Branch

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From the Department of State Health Services Immunization Branch

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April 13, 2011

Tdap Vaccine Recommendations Update

The goal of the Vaccine Advisory is to disseminate, in a timely manner, practical information related to vaccines, vaccine-preventable diseases, and the vaccine programs managed by the Immunization Branch.The Immunization Branch welcomes readers’ input to improve the contents of this document.


On October 27, 2010, the Advisory Committee on Immunization Practices (ACIP) approved expanded recommendations for the use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap) vaccine.

This advisory provides a summary of the updated recommendations.

This advisory contains:


Top of Page   1) Background information

Two Tdap vaccines are available in the United States (Boostrix [GlaxoSmithKline] and Adacel [Sanofi Pasteur]). Both vaccines provide the same protection from tetanus, diphtheria and pertussis.

Despite high coverage for childhood pertussis vaccination, pertussis remains poorly controlled in the United States. A total of 16,858 pertussis cases and 12 infant deaths were reported in 2009. Although 2005 recommendations by the ACIP called for vaccination with tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap) for adolescents and adults to improve immunity against pertussis, Tdap coverage is 56% among adolescents and <6% among adults.
In October 2010, ACIP recommended expanded use of Tdap. Three new recommendations were approved. 

Top of Page   2) Summary of ACIP's recommendations for Tdap vaccine

The updated recommendations apply to both licensed Tdap products (Boostrix and Adacel). Both Tdap products are licensed for use at an interval of at least 5 years between the tetanus and diphtheria toxoids (Td) and Tdap dose. ACIP approved the following additional recommendations:

  • Tdap can be administered regardless of interval since the last tetanus- or diphtheria-toxoid containing vaccine.
  • Adults ages 65 years and older (e.g., grandparents, child-care providers, and health-care practitioners) who anticipate having close contact with an infant less than 12 months of age and who have not previously received a dose of Tdap should receive a single dose of Tdap. For all other adults ages 65 and older, a single dose of Tdap vaccine may be given in place of Td vaccine. 
  • Children ages 7 through 10 who are not fully vaccinated* should receive a single dose of Tdap.

The full recommendations are published in the January 14, 2011 edition of the Centers for Disease Control and Prevention (CDC) and may be found at Morbidity and Mortality Weekly Report (MMWR).

*Fully vaccinated is defined as 5 doses of DTaP or 4 doses of DTaP if the fourth dose was administered on or after the fourth birthday.

Top of Page   3) Texas Vaccines for Children program

Changes in Tdap recommendations include vaccinating TVFC-eligible children with Tdap at ages 7 to 10 years, and eliminating the minimum interval from the previous diphtheria-toxoid (Td) vaccination.

Tdap is indicated for a single booster dose at age 11 or 12 years if the childhood DTP/DTaP vaccination series has been completed. Tdap is preferred over Td as adolescents are susceptible to pertussis due to waning immunity, though Td may be indicated rather than Tdap in special situations (more information is available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5503a1.htm?s_cid=rr5503a1_e).

Adolescents who did not receive Tdap at age 11 or 12 should receive a single dose of Tdap in place of a single Td booster dose. Tdap can be administered regardless of interval since the last tetanus or diphtheria containing vaccine.

Tdap should be given to children 7 through 18 years of age who:

  • have received tetanus and diphtheria containing vaccines (DT or Td) instead of DTP/DTaP for some or all doses of the childhood series;
  • have received fewer than 5 doses of DTP/DTaP or 4 doses if the fourth dose was administered at age 4 years or older; or
  • have never been vaccinated against tetanus, diphtheria, or pertussis (no doses of pediatric DTP/DTaP/DT or Td). The preferred schedule is a single Tdap dose, followed by a dose of Td four weeks after the first dose and a second dose of Td 6-12 months later. If not administered as the first dose, Tdap can be substituted for any of the other Td doses in the series.  For Tdap catch-up, refer to the following chart.

Dosage Intervals for Tdap Catch-up

Vaccine

Minimum Age

Minimum interval between doses

Dose

1-2

Dose

2-3

Dose

3-4

Tdap/Td Catch –up schedule

7 years

4 weeks

6 months

5 years

More information about the catch-up is available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5503a1.htm?s_cid=rr5503a1_e.

For other questions or information, please contact your health service region, or TVFC consultant.

Top of Page   4) ImmTrac

ImmTrac users can report Tdap vaccines administered using CPT code 90715.

For more information about ImmTrac, please refer to: www.ImmTrac.com

Top of Page   5) Texas school and child-care facilities requirements for Tdap vaccine

In 2009, the state of Texas adopted new Tdap immunization requirements. Following is a highlight of the new Tdap requirements:

  • 7th grade students – All students entering 7th grade are required to have one dose of Tdap vaccine if at least 5 years have passed since their last dose of a tetanus-diphtheria-containing vaccine.
  • 8th through 12th grade students – Students in grades 8-12 are required to have a booster dose of Tdap if it has been 10 years since their last dose of tetanus-diphtheria-containing vaccine. Td is acceptable in place of Tdap if a medical contraindication to pertussis exists.

A chart of all the required vaccines can be viewed at http://www.dshs.state.tx.us/immunize/school/default.shtm#infoforschoolchildcare

Top of Page   6) Epidemiology and surveillance

Pertussis, or whooping cough, is an acute, highly infectious, toxin-mediated disease caused by the bacterium Bordetella pertussis. Disease in adolescents and adults may be milder and go undetected in these individuals. They are still capable of transmitting the disease, especially to those most vulnerable, infants. In 2010, approximately 2700 cases of pertussis occurred in Texas. This is a decrease from the previous year when over 3300 cases were reported, 3 of which resulted in death (there were no deaths in 2010). Pertussis typically peaks in 3-5 year cycles. 2005 was a peak year in Texas and across the United States. 2009 appears to have been a peak year in Texas. The majority of cases occur among infants younger than 1 year of age. Pertussis is a reportable condition in Texas. All suspected cases are to be reported to the health department within 1 working day. To report pertussis, please call 800-705-8868.

Top of Page   7) Reporting vaccine adverse events

An adverse event is a health problem that is reported after someone gets a vaccine or medicine.

Adverse events from privately purchased vaccine should be reported directly to VAERS at http://vaers.hhs.gov/. Secure web-based reporting is available on the VAERS website. You may also contact VAERS at (800) 822-7967 for forms and information.

In Texas, reports of adverse events following vaccination at public health clinics or with vaccine provided through public funding such as the Texas Vaccines for Children (TVFC) program should be reported through the Texas Department of State Health Services, Immunization Branch via fax or mail.

  • Fax a completed VAERS Form to:1-866-624-0180 (toll-free)
  • Mail a completed VAERS form to DSHS, Immunization Branch, MC-1946, P.O. Box 149347, Austin, TX 78714-9347

A pre-addressed postage-paid VAERS form can be obtained by calling the Immunization Branch. A copy of the form is also available in the TVFC Toolkit. For more information about VAERS, you can contact DSHS at 800- 252-9152.

Top of Page   8) Resources


We hope you generously forward this advisory to others who may benefit from this information.

Texas Department of State Health Services Immunization Branch (MC-1946) 
P.O. Box 149347, Austin, Texas 78714-9347. (512) 458-7284 or (800) 252-9152
www.ImmunizeTexas.com


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Last updated April 15, 2011