Pertussis Booster Vaccination in Adulthood

Recommendations for Adult Pertussis Vaccination

• The Centers for Disease Control and Prevention recommends that adults aged 19-64 years should receive a single dose of Tdap to replace a single dose of Td for booster immunization if they received their last dose of Td >10 years earlier and have not previously received Tdap 1, 3
• The Advisory Committee on Immunization Practices (ACIP) specifically recommends a single dose of Tdap for all adults who have not previously received it, regardless of the time since their last tetanus or diphtheria toxoid-containing vaccine 3, 4

Special Considerations for High-Risk Groups

• Adults who have or anticipate having close contact with infants aged <12 months should receive a single dose of Tdap if not previously vaccinated, with an interval as short as 2 years from the last Td suggested for these individuals 4
• Healthcare personnel who work in hospitals or ambulatory care settings with direct patient contact should receive a single dose of Tdap as soon as feasible if not previously vaccinated, with an interval as short as 2 years from the last dose of Td recommended for healthcare workers 4

Rationale for Adult Pertussis Vaccination

• Immunity to pertussis wanes approximately 5-10 years after completion of childhood vaccination, leaving adolescents and adults susceptible to pertussis 1, 2, 3
• Adolescents and adults with waning immunity are a major reservoir for transmission of pertussis, particularly to vulnerable infants 5, 6
• Pertussis remains endemic in the United States despite longstanding routine childhood pertussis vaccination, and is the least well-controlled among reportable bacterial vaccine-preventable diseases for which universal childhood vaccination has been recommended 3

Vaccine Efficacy and Safety

• Prelicensure studies demonstrated safety and efficacy (inferred through immunogenicity) against tetanus, diphtheria, and pertussis when Tdap was administered as a single booster dose to adults 7
• The efficacy of an acellular pertussis vaccine was 92% (95% CI = 32%-99%) against confirmed pertussis in a randomized trial in the United States 2

Implementation Considerations

• Every visit of an adult to a healthcare provider should be regarded as an opportunity to assess vaccination status and provide protection against tetanus, diphtheria, and pertussis 5, 8
• After receiving a single dose of Tdap, subsequent tetanus and diphtheria protection should follow the standard decennial Td booster schedule, beginning 10 years after receipt of Tdap 4

Historical Context

• Prior to 2005, routine vaccination against pertussis was not recommended for persons ≥7 years of age, though it was recognized that adolescents and adults with waning immunity were a major reservoir for transmission 9, 5, 6
• In 2005, Tdap vaccines formulated for use in adults and adolescents were licensed in the United States, leading to the current recommendations for adult booster doses 3