MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports ; v. v. 55, no. RR-17

Introduction -- Pertussis Vaccination Policy -- Objectives of Adult Pertussis Vaccination Policy -- -- Background: Pertussis -- General Characteristics -- Clinical Features and Morbidity Among Adults with Pertussis -- Infant Pertussis and Transmission to Infants -- Pertussis Diagnosis -- Burden of Pertussis Among Adults -- -- Background: Tetanus and Diphtheria -- Tetanus -- Diphtheria -- -- Adult Acellular Pertussis Vaccine Combined with Tetanus and Diphtheria Toxoids -- ADACEL® -- -- Safety Considerations for Adult Vaccination with Tdap -- Spacing and Administration Sequence of Vaccines Containing Tetanus Toxoid, Diphtheria Toxoid, and Pertussis Antigens -- Neurologic and Systemic Events Associated with Vaccines with Pertussis Components or Tetanus Toxoid-Containing Vaccines -- -- Economic Considerations for Adult Tdap Use -- Economic Burden -- -- Implementation of Adult Tdap Recommendations -- Routine Adult Tdap Vaccination -- Vaccination of Adults in Contact with Infants -- Vaccination of Pregnant Women -- -- Pertussis Among Health-Care Personnel -- -- Recommendations -- Routine Tdap Vaccination -- Contraindications and Precautions for Use of Tdap -- Special Situations for Tdap Use -- Reporting of Adverse Events After Vaccination -- Vaccine Injury Compensation -- Areas of Future Research Related to Tdap and Adults -- -- Acknowledgments -- References -- Appendix A. Summary of Recommendations for Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccine (Tdap) Use Among Adults -- Appendix B. CDC and Council of State and Territorial Epidemiologists (CSTE) Pertussis Case Definition -- Appendix C. Abbreviations Used in This Report

On June 10, 2005, a tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine (Tdap) formulated for use in adults and adolescents was licensed in the United States for persons aged 11--64 years (ADACEL®, manufactured by sanofi pasteur, Toronto, Ontario, Canada). 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. To reduce pertussis morbidity among adults and maintain the standard of care for tetanus and diphtheria prevention and to reduce the transmission of pertussis to infants and in health-care settings, the Advisory Committee on Immunization Practices (ACIP) recommends that: 1) adults aged 19--64 years should receive a single dose of Tdap to replace tetanus and diphtheria toxoids vaccine (Td) for booster immunization against tetanus, diphtheria, and pertussis if they received their last dose of Td >10 years earlier and they have not previously received Tdap; 2) intervals shorter than 10 years since the last Td may be used for booster protection against pertussis; 3) adults who have or who anticipate having close contact with an infant aged <12 months (e.g., parents, grandparents aged <65 years, child-care providers, and health-care personnel) should receive a single dose of Tdap to reduce the risk for transmitting pertussis. An interval as short as 2 years from the last Td is suggested; shorter intervals can be used. When possible, women should receive Tdap before becoming pregnant. Women who have not previously received Tdap should receive a dose of Tdap in the immediate postpartum period; 4) health-care 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 if they have not previously received Tdap. An interval as short as 2 years from the last dose of Td is recommended; shorter intervals may be used. These recommendations for use of Tdap in health-care personnel are supported by the Healthcare Infection Control Practices Advisory Committee (HICPAC). This statement 1) reviews pertussis, tetanus and diphtheria vaccination policy in the United States; 2) describes the clinical features and epidemiology of pertussis among adults; 3) summarizes the immunogenicity, efficacy, and safety data of Tdap; and 4) presents recommendations for the use of Tdap among adults aged 19--64 years.

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