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Tdap Vaccine
Aka: Tdap Vaccine, Tdap, Tetanus Diptheria Acellular Pertussis Vaccine, Adacel, Boostrix
- See Also
- Td Vaccine
- DTaP Vaccine
- Pertussis
- Diptheria
- Tetanus
- Indications
- See Tetanus Prophylaxis
- Primary Series booster at age 11 years old
- Catch-Up incomplete Primary Series age >7 years old
- Adults 18 to 64 years old for Tetanus booster every 10 years (may substitute for any Td dose)
- Pregnant women in third trimester (repeat with each pregnancy)
- Preparations
- Tdap has reduced Antigen concentrations of diptheria and Pertussis than DTaP
- Reduces side effects
- Products
- Boostrix (approved for adolescents ages 10 to 18)
- Adacel (approved for ages 11 to 64 years)
- Precautions
- Pertussis in age <2 months is highest Incidence (160 per 100,000) and high risk (80% hospitalization rate)
- Tdap Vaccination is most important for protecting infants from community exposure
- (2013) MMWR Morb Mortal Wkly Rep 62(7): 131-5 [PubMed]
- Adverse Effects
- Injection Site Pain
- Severe in 20% of adults
- More common with subsequent injections
- Flu-Like Symptoms
- Occurs in 10% of cases
- Low-grade Fever (<38 C, 101 F)
- Low grade fever occurs in 13% of patients
- Neurologic complications
- Seizures are rare (except in Dravet Syndrome)
- Transient Brachial Neuritis (rare)
- Guillain Barre Syndrome (rare)
- Dosing: Schedule
- Maintenance with Tdap for teens
- Age 11-12 years: Give Tdap instead of Td
- Age 13-18 years: Give Tdap if no Td given yet
- Consider Tdap instead of Td
- Maintenance for adults
- Usual interval between Tdap doses
- Tdap Vaccine at 11-12 years
- Td or Tdap every 10 years
- Single Tdap dose replaces the Td at least once between 19 to 64 years old
- See below for additional Tdap dose indications
- Tdap may be given for over age 64 once
- Indications for shorter interval between Tdap doses
- Pregnancy
- Regular contact with newborns (e.g. healthcare workers, childcare workers)
- Consider early booster during local Pertussis epidemic (e.g. 2012 in U.S.)
- Following contaminated wound if >5 years from prior Vaccine
- Minimal interval between doses (usual interval is 10 years)
- Last tetanus Immunization was Tdap
- General population: Minimum of 5 years from last Tdap dose
- Regular contact with newborns: Minimum of 2 years from last Tdap dose
- Last tetanus Immunization was Td
- No minimum interval between Td and subsequent Tdap
- Administer Tdap now to any adult in contact with newborns
- Maintenance for pregnancy
- Booster with known prior Immunization
- Give Tdap at 27-36 weeks gestation for EACH pregnancy
- Allows time for maternal Pertussis antibodies to transfer to the baby (passive Immunity)
- (2013) Ann Intern Med 158(3):191-9 [PubMed]
- Series if Immunization Status Unknown
- Dose 1: Tdap at 20 weeks gestation
- Dose 2: Td at one month after the first
- Dose 3: Td at 6 to 12 months after the first
- Efficacy
- Immunity from tetanus Vaccination appears to be far more long lasting than 10 years
- Hammarlund (2016) Clin Infect Dis 62(9):1111-8 +PMID: 27060790 [PubMed]
- References
- Ackerman (2015) Am Fam Physician 92(6): 460-8 [PubMed]