Vaccine advisors streamline pertussis advice for adults

Feb 22, 2012 (CIDRAP News) – Federal vaccine advisors today simplified their pertussis immunization recommendation for adults by advising that all those over age 19—including seniors 65 and older—should receive one dose of tetanus, diphtheria, and pertussis (Tdap) vaccine if they haven't received it already.

Today's action by the Centers for Disease Control and Prevention's (CDC's) Advisory Committee on Immunization Practices (ACIP) follows last summer's approval of the first Tdap vaccine for seniors. Boostrix vaccine, made by GlaxoSmithKline, is given as a single dose and is the first vaccine to prevent all three diseases in older people.

An ACIP working group has been focusing on shoring up gaps in pertussis vaccination over the past few years, and its work took on added urgency in 2010 when a pertussis surge in California pushed the number of infections to a 60-year high and killed 10 babies.

In October 2010 ACIP fine-tuned its recommendations, allowing children ages 7 through 9 who are aren't completely vaccinated to receive the Tdap vaccine and permitting seniors older than 64 who have contact with babies to be immunized with Tdap, even though at the time the vaccine wasn't approved for their age-group.

The recommendation for adults under age 65 has been one dose of Tdap if the patient has not received one before, with the option for Tdap to be given as a replacement for a 10-year tetanus and diphtheria (Td) shot.

Today's vote, which passed by 14 to 1, replaces a two-tiered recommendation for younger and older adults with a single recommendation for everyone older than 19. The CDC typically accepts ACIP's recommendations.

CDC officials emphasized that adults can get Tdap even if they recently had a Td booster and that even people who were vaccinated against pertussis as children need a dose of Tdap as a teen or adult, because protection ebbs over time.

At today's meeting, ACIP members heard updates on the disease and presentations on the cost-effectiveness of the vaccine and its safety in seniors.

Anna Acosta, MD, with the CDC's National Center for Immunization and Respiratory Diseases, told committee members that physicians face challenges in recognizing pertussis in adults. Adults don't often have the two hallmark symptoms seen in children—the whoop and emesis after coughing.

Pertussis may be an important contributor to pneumonia hospitalizations in older people, and the disease may be underreported in adults, she said. Reported pertussis infection levels are 65 to 80 times higher in Australia, which has a serology component in its case definition, than in the United States, she commented.

ACIP members said they were reassured by safety data on the pertussis vaccine for seniors, but some said they were troubled by the lack of vaccine efficacy data and wanted more information on waning immunity after vaccination. Acosta said the working group would continue to explore the issues and that the group will hear evidence updates when the committee revisits the pertussis recommendation at its 5-year review.

See also:

Jul 8, 2011, CIDRAP News Scan "FDA approves Tdap vaccine for those over 65"

Oct 27, 2010, CIDRAP News story "CDC advisors recommend steps to fill pertussis vaccine gaps"

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