More Aggressive Whooping Cough Vaccine Use Advised

Larry Hand

September 26, 2011

September 26, 2011 — The American Academy of Pediatrics and the US Centers for Disease Control and Prevention have revised their recommendations on the whooping cough vaccine to call for the administration of 1 vaccine at particular ages and with minimal intervals between vaccinations, according to a new policy statement published online September 26 in Pediatrics.

"There are a lot of places where we have opportunities to have a positive impact, and if we don't take advantage of all of them, we're not likely to be successful," said Michael Brady, MD, from Nationwide Children's Hospital in Columbus, Ohio, and chair of the American Academy of Pediatrics' infectious diseases committee. "We're finding that 7- to 10-year-olds are underimmunized, and that older adolescents, if immunized at age 11, by the time they get to age 17 or 20, they're probably not protected. Also, we're giving the vaccine to mothers during pregnancy, rather than after delivery, because that will protect the mothers, and the mothers will develop the antibodies that they will give to their babies."

The 2 groups removed their previous minimum interval between administering a tetanus or diphtheria vaccine and the tetanus toxoid, reduced-content diphtheria toxoid, and acellular pertussis vaccine (Tdap) based on a committee's review of clinical trials and other studies that cited no excess adverse reaction when Tdap is given shortly after tetanus and diphtheria toxoid vaccine (Td). To help to prevent pertussis, the 2 groups recommend a single dose of Tdap for children aged 7 to 10 years who may have been underimmunized with DTaP or whose immunization history is incomplete. For those children who are up-to-date with DTaP, Tdap is routinely recommended at age 11 or 12 years.

At this time, the standard schedule for whooping cough vaccines lists shots at ages 2, 4, 6, and 15 to 18 months, as well as at ages 4 to 6 years and 11 to 12 years. Tdap is one of a group of pertussis vaccines used and was the first approved for ages 7 years and older.

The groups recommend extending the age for administering Tdap to people aged 65 years and older and to healthcare workers of all ages — anyone who may come in contact with infants too young for vaccination — because research has shown that grandparents are often caregivers for infants. The groups also recommend vaccination of adolescents, including pregnant adolescents, and pregnant women, whereas previously the recommendation was to wait until after pregnancy.

Two Tdap vaccines are licensed in the United States: Boostrix (GlaxoSmithKline Biologicals, Research Triangle Park, NC) and Adacel (Sanofi Pasteur, Swiftwater, PA). The US Food and Drug Administration recently approved an extended age indication for Boostrix, going from ages 10 through 64 years to ages 10 years and older, as reported in the September 23 Morbidity and Mortality Weekly Report. The authors of that report wrote that Tdap can be administered with other vaccines during the same office visit. Adacel is approved for ages 11 through 64 years.

Practitioners will have to use Tdap off-label to meet this new recommendation, which coincides with a preliminary report published last week indicating that the effectiveness of early-childhood whooping cough vaccines may not last as long as they are intended to last. A group from Kaiser Permanente Medical Center in San Rafael, California, presented results from a study of an outbreak of whooping cough that killed 11 infants and caused 9100 people to get sick in 2010. Fully immunized children aged 8 to 12 made up most of those cases. Researchers suggested that the effectiveness of the vaccinations at younger ages may have waned.

The California group basically documented what is happening in multiple locations, said Dr. Brady, who added that the research points to the need for a booster in this age group.

The body of research that went into the new guidelines dates back to the 1980s, said Sarah Long, MD, from St. Christopher's Hospital for Children in Philadelphia, Pennsylvania, and lead author of the American Academy of Pediatrics policy statement. The California report "tells you that you can still have deaths in the United States from vaccine-preventable diseases and we need to do all we can to implement vaccines in the age groups that that will protect those around them."

Pediatrics. Published online September 26, 2011. Full text


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