COMMENTARY

Tdap: Now for Pregnant Women and 65 Plus

Jennifer Liang, DVM, MPVM

Disclosures

October 31, 2011

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Hi, I'm Dr. Jennifer Liang. Thanks for tuning into this CDC Expert Video Commentary on Medscape. I'd like to update you on the latest recommendations for preventing pertussis by using Tdap vaccine for pregnant women and adults 65 years of age and older.

In 2010, more than 27,000 pertussis cases were reported in the United States. Vaccination remains the best way to prevent pertussis among your patients; DTaP vaccine for infants and young children and the Tdap vaccine for adolescents and adults. Current routine recommendations call for:

  • A dose of DTaP vaccine at 2, 4, 6, and 15-18 months of age, with a booster shot at 4-6 years of age;

  • A dose of Tdap vaccine at age 11 or 12 years; and

  • For adolescents and adults through 64 years of age who have never received Tdap, a dose as soon as possible, no matter when they last got a Td shot.

The 2 Tdap vaccines that we currently use for adolescents and adults were originally licensed for use up through 64 years of age. Despite these age limitations, in 2010, CDC's Advisory Committee on Immunization Practices, (ACIP) voted to recommend use of Tdap vaccine among those 65 years and older, especially those who will have close contact with an infant. Then in July 2011, the US Food and Drug Administration approved an expanded age indication for 1 of the 2 Tdap vaccines (Boostrix®; GlaxoSmithKline; London, United Kingdom) licensing its use in those 65 years and older. However, until ACIP discusses the licensure data, either Tdap product may be used in this age group.

Including older adults in pertussis vaccine recommendations can prevent cases of pertussis among this age group. By vaccinating grandparents, fewer infants will be exposed to pertussis. This strategy of protecting infants by vaccinating those around them is known as cocooning. Infants have the highest rates of hospitalizations and deaths due to pertussis. More than 100 infants have died since 2004 due to complications related to pertussis infection -- in 2010, more than 20 infant deaths were reported. Since 2005, as part of the cocooning strategy, ACIP has recommended Tdap vaccines be given to unvaccinated mothers and family members of newborn infants.

In June 2011, ACIP voted to recommend that women's healthcare providers should implement a maternal Tdap vaccination program for women who have not previously received the vaccine. Healthcare providers should administer Tdap preferably during the third or late second trimester (after 20 weeks' gestation). Alternatively, you can continue to administer the vaccine immediately postpartum.

The reasoning is that for infants, transplacental transfer of maternal pertussis antibodies may provide protection against pertussis in early life, before beginning the primary DTaP series. There is evidence of efficient transplacental transfer of pertussis antibodies to infants. The effectiveness of maternal antibodies in preventing infant pertussis is not yet known, but pertussis antibodies can protect against some disease and the severe outcomes that comes along with it. A woman vaccinated with Tdap vaccine during pregnancy will also be protected at the time of delivery and will be less likely to transmit pertussis to her infant.

As you talk to your patients about benefits of the vaccine, you can also reassure them that ACIP concluded that there is no elevated frequency or unusual occurrence of adverse events among pregnant women who received Tdap vaccine, or in their newborns.

To enhance the protection of cocooning, ACIP continues to recommend that unvaccinated adolescents and adults who have or anticipate having close contact with an infant younger than 12 months of age should receive a single dose of Tdap vaccine to protect against pertussis. Ideally, these adolescents and adults should receive the vaccine at least 2 weeks before beginning close contact with the infant. For more information about pertussis and pertussis vaccines, visit www.cdc.gov/pertussis. Thanks for tuning in today.

Web Resources

CDC. Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap) vaccine from the Advisory Committee on Immunization Practices, 2010. MMWR Morb Mortal Wkly Rep. 2011;60:13-15. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6001a4.htm?s_cid=mm6001a4_w Accessed July 22, 2011.

CDC. Updated Recommendations for Use of Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis (Tdap) Vaccine in Pregnant Women and Persons Who Have or Anticipate Having Close Contact with an Infant Aged Less than 12 Months -- Advisory Committee on Immunization Practices (ACIP), 2011. MMWR. 2011;60:1424-1426. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6041a4.htm?s_cid=mm6041a4_e%0d%0a. Accessed October 27, 2011.

CDC. FDA Approval of Expanded Age Indication for a Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccine. MMWR 2011;60:1279-1280. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6037a3.htm?s_cid=mm6037a3_w. Accessed October 27, 2011.

CDC Pertussis Clinician Website
http://www.cdc.gov/pertussis/clinical/index.html

Pertussis Vaccines -- Recommendations and Licensures
http://www.cdc.gov/pertussis/pubs-tools/pubs-textbks.html#articles

Jennifer L. Liang, DVM, MPVM , is an epidemiologist in the Meningitis and Vaccine Preventable Diseases Branch (MVPDB) in the Division of Bacterial Diseases of the National Center for Immunization and Respiratory Diseases where she works on pertussis-related issues. Dr. Liang also serves as the CDC lead for the ACIP Pertussis Vaccines Working Group.

Prior to joining MVPDB, Dr. Liang served as an Epidemic Intelligence Service Officer in the Division of Parasitic Diseases at CDC in 2005 and a CDC Prevention Effectiveness Fellow at the DeKalb County Board of Health (Decatur, Georgia) in 2007.

Dr. Liang received her veterinary medical degree from Purdue University and her masters degree from the University of California, Davis.

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