American Academy of Pediatrics Updates Pertussis Booster Vaccine Guidelines

Grandma needs a shot to protect the baby

Pertussis, a.k.a. whooping cough is a nasty disease. It is particularly merciless with our youngest. Last year in California 10 babies died, of which 9 were under 2 months of age and were thus too young to be vaccinated with the first of the 5 doses of the DTaP vaccine. Thus, it is imperative that we do all we can to protect the youngest in our midst from this deadly disease.

In line with this need for extra protection for our children, the American Academy of Pediatrics has updated its guidelines about the use of the pertussis booster (Tdap) vaccine. In light of the recent news that immunity from the vaccine might wane sooner than previously thought, these updated recommendations become that much more important.

The current AAP and CDC recommendation regarding the booster shots are as follows:

• A single dose of Tdap for adolescents aged 11-18 years of age who have completed the recommended DTaP series
• A dose of Tdap every 10 years to replace the Td booster for adults 19-64 years of age
• A minimum interval of 5 years (2 years for special circumstances) interval before receiving the Tdap, if individual had received another tetanus toxoid- or diphtheria toxoid- containing vaccine.
• Tdap booster is not licensed for use with persons 65 years and older.

The main changes to the current guidelines are:

• Removal of minimum interval between receipt of Tdap and other tetanus – or diphtheria - containing toxoid vaccine - In 2005, when the Tdap was first licensed for use, there was very little data on any possible reactions of Tdap given soon after another tetanus toxoid- or diphtheria toxoid- containing vaccine. Therefore a cautionary approach was taken recommending a minimum interval of 5 years (or 2 years in special circumstances). Data collected since then has shown that it is safe to take the Tdap booster soon after having received a Td shot. However, the sample sizes of the studies on which this recommendation is based are small, so a rare but significant event cannot be completely excluded.
• A single dose of Tdap is now recommended for children 7-10 years of age who were underimmunized with DTaP. At their 11-12 year visit, when they would normally have received their booster shot, a TD only shot is recommended since the Tdap is not licensed for multiple doses for this age group.
• The age recommendation is extended to those 65 or older who are likely to have contact with an infant younger than 12 months (includes grandparents, caregivers and health care personnel) – Although the Tdap vaccine is not licensed for use by persons 65 years or older, VAERS data and other as of yet unpublished data support the recommendation that persons over 65 at high risk of potential transmission to young infants be given the booster shot. The CDC at this time does not recommend immunizing all persons over 65 years, however there are no contraindications to immunizing persons in this age group and anyone who wishes to get it can.