1. Adult Immunization 2010 Tetanus, Diphtheria and Pertussis Segment This material is in the public domain This information is valid as of May 25, 2010

2. NOTE: 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 http://www.cdc.gov/vaccines/recs/schedules/adult-schedule.htm http://www.cdc.gov/vaccines/recs/schedules/adult-schedule.htm

3. 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 years

4. Reported Pertussis by Age Group, 1990-2008

5. 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

6. 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

7. 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

8. 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)

9. Minimum Interval Between Td and Tdap ACIP did not define an absolute minimum interval between Td and Tdap 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)

10. 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)

11. 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 younger Other HCP should receive a single dose of Tdap to replace the next scheduled Td MMWR 2006;55(RR-17)

12. 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

13. 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

14. Tdap/Td Adverse Reactions Pain 66% - 75% Redness 23% - 24% Swelling 21% Temperature 3% - 5% (100°F or higher) Systemic 30% - 40%

15. National Center for Immunization and Respiratory Diseases Contact Information Telephone (800) CDC-INFO Email nipinfo@cdc.govnipinfo@cdc.gov Website http:///www.cdc.gov/vaccines/ http:///www.cdc.gov/vaccines/ Broadcast Updates and Resources Web Page www.cdc.gov/vaccines/ed/webcasts.htm