Tdap Vaccine

1. See Also
   1. Td Vaccine
   2. DTaP Vaccine
   3. Pertussis
   4. Diptheria
   5. Tetanus
2. Indications
   1. Pimary series booster at age 11 years old
   2. Adults 18 to 64 years old for Tetanus booster every 10 years (may substitute for any Td dose)
   3. Pregnant women in third trimester (repeat with each pregnancy)
3. Preparations
   1. Tdap has reduced antigen concentrations of diptheria and Pertussis than DTaP
      1. Reduces side effects
   2. Products
      1. Boostrix (approved for adolescents ages 10 to 18)
      2. Adacel (approved for ages 11 to 64 years)
4. Precautions
   1. Pertussis in age <2 months is highest Incidence (160 per 100,000) and high risk (80% hospitalization rate)
      1. Tdap Vaccination is most important for protecting infants from community exposure
      2. (2013) MMWR Morb Mortal Wkly Rep 62(7): 131-5 [PubMed]
5. Adverse Effects
   1. Injection Site Pain
      1. Severe in 20% of adults
      2. More common with subsequent injections
   2. Flu-Like Symptoms
      1. Occurs in 10% of cases
   3. Low-grade Fever (<38 C, 101 F)
      1. Low grade fever occurs in 13% of patients
   4. Neurologic complications
      1. Seizures are rare (except in Dravet Syndrome)
      2. Transient Brachial Neuritis (rare)
      3. Guillain Barre Syndrome (rare)
6. Dosing: Schedule
   1. Maintenance with Tdap for teens
      1. Age 11-12 years: Give Tdap instead of Td
      2. Age 13-18 years: Give Tdap if no Td given yet
         1. Consider Tdap instead of Td
   2. Maintenance for adults
      1. Usual interval between Tdap doses
         1. Tdap Vaccine at 11-12 years
         2. As of 2011, ACIP recommends:
            1. Td every 10 years
               1. Single Tdap dose replaces the Td once between 19 to 64 years old
               2. See below for additional Tdap dose indications
            2. Tdap may be given for over age 64 once if close infant contact (off label use)
      2. Indications for shorter interval between Tdap doses
         1. Pregnancy
         2. Regular contact with newborns (e.g. healthcare workers, childcare workers)
         3. Consider early booster during local Pertussis epidemic (e.g. 2012 in U.S.)
      3. Minimal interval between doses (usual interval is 10 years)
         1. Last tetanus Immunization was Tdap
            1. General population: Minimum of 5 years from last Tdap dose
            2. Regular contact with newborns: Minimum of 2 years from last Tdap dose
         2. Last tetanus Immunization was Td
            1. No minimum interval between Td and subsequent Tdap
            2. Administer Tdap now to any adult in contact with newborns
   3. Maintenance for pregnancy
      1. Booster with known prior Immunization
         1. Give Tdap at 27-36 weeks gestation for EACH pregnancy
         2. Allows time for maternal Pertussis antibodies to transfer to the baby (passive immunity)
         3. (2013) Ann Intern Med 158(3):191-9 [PubMed]
      2. Series if Immunization Status Unknown
         1. Dose 1: Tdap at 20 weeks gestation
         2. Dose 2: Td at one month after the first
         3. Dose 3: Td at 6 to 12 months after the first
7. References
   1. Ackerman (2015) Am Fam Physician 92(6): 460-8 [PubMed]