Diphtheria Tetanus Pertussis Slides Tetanus Diphtheria and

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					   Adult Immunization 2010

Tetanus, Diphtheria and Pertussis

    This material is in the public domain
 This information is valid as of May 25, 2010
Participants are strongly encourage to
have a copy of the current adult
immunization schedule available
during this program.

The current schedule can be
downloaded from the CDC Vaccines
and Immunizations website at
Tetanus and Diphtheria Immunity
• More than 50% of adults 20 years of
  age and older in the U.S. do not have
  a protective level of antibody against
  tetanus and diphtheria
• Many adults 60 years of age and
  older have not received a primary
  series of tetanus- and diphtheria-
  containing vaccine
• Many adults of all ages do not receive
  routine Td booster doses every 10
         Reported Pertussis by Age
             Group, 1990-2008
                              <11   11-18    >18

                1990   1995           2000         2005
      Tetanus and Diphtheria
       Vaccines for Adults
• Tetanus and Diphtheria Toxoid (Td)
  –formalin-inactivated toxins
  –3 doses induces protective
   antibody in nearly everyone
  –protection for at least 10 years
• Tdap
          Tdap Vaccines

• Boostrix (GlaxoSmithKline)
  –single dose
  –approved for persons 10 through 64
   years of age
• Adacel (sanofi pasteur)
  –single dose
  –approved for persons 11 through 64
   years of age
   General Principles for Use
       of Tdap and Td
• No brand preference
• Tdap preferred to Td to provide
  protection against pertussis
• Approved as a single booster dose in
  persons who have previously
  received a full series of pediatric
  DTaP or DTP
Persons Without Documentation of
      Pertussis Vaccination
• All adults should have documentation of
  having received a series of DTaP, DTP,
  DT, or adult Td
• Adults without documentation should
  receive or complete a series of 3 doses
• Preferred schedule*:
   – single dose of Tdap
   – Td at least 4 weeks after the Tdap dose
   – second dose of Td at least 6 months
     after the Td dose
 *off-label recommendation. See MMWR 2006;55(RR-17)
   Minimum Interval Between
         Td and Tdap
• ACIP did not define an absolute
  minimum interval between Td and
• Provider will need to decide based on
  whether the benefit of pertussis
  immunity outweighs the risk of a
  local adverse reaction

  MMWR 2006;55(RR-17)
          Tdap and Pregnancy
• Td is generally preferred during pregnancy
• All women should receive a dose of Tdap in
  the immediate postpartum period
• Any woman who might become pregnant is
  encouraged to receive a single dose of Tdap
• A clinician may choose to administer Tdap to
  a pregnant woman in certain circumstances,
  such as during an outbreak of pertussis in
  the community
• Pregnancy is not a contraindication to
  vaccination with Tdap

  MMWR 2008;57(RR-4)
         Tdap and Healthcare
           Personnel (HCP)
• Healthcare personnel who work in
  hospitals or ambulatory care settings and
  have direct patient contact should receive
  a single dose of Tdap as soon as feasible
• Priority should be given to vaccination of
  healthcare personnel who have direct
  contact with infants 12 months of age and
• Other HCP should receive a single dose of
  Tdap to replace the next scheduled Td

 MMWR 2006;55(RR-17)
      Tdap Contraindications

• Severe allergic reaction to a vaccine
  component or following a prior dose
• Encephalopathy within 7 days of
  administration of a pertussis vaccine
  that is not attributable to another
  identifiable cause
         Tdap Precautions
• History of an Arthus-type reaction
  following a previous dose of tetanus or
  diphtheria toxoid-containing vaccine
• Progressive neurologic disorder,
  uncontrolled epilepsy, or progressive
  encephalopathy until condition stabilized
• History of Guillain-Barré syndrome (GBS)
  within 6 weeks after a previous dose of
  tetanus toxoid-containing vaccine
• Moderate or severe acute illness
Tdap/Td Adverse Reactions

• Pain                66% - 75%
• Redness             23% - 24%
• Swelling               21%
• Temperature          3% - 5%
  (100°F or higher)
• Systemic            30% - 40%
 National Center for Immunization
     and Respiratory Diseases
          Contact Information
• Telephone   (800) CDC-INFO
• Email       nipinfo@cdc.gov
• Website http:///www.cdc.gov/vaccines/

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