Prevention of Pertussis, Tetanus, and Diphtheria with Vaccines in the United States: Recommendations of the Advisory Committee on Immunization Practices (ACIP)

Abstract

SummaryThis report compiles and summarizes all recommendations from CDC's Advisory Committee on Immunization Practices (ACIP) regarding prevention and control of tetanus, diphtheria, and pertussis in the United States. As a comprehensive summary of previously published recommendations, this report does not contain any new recommendations and replaces all previously published reports and policy notes; it is intended for use by clinicians and public health providers as a resource. ACIP recommends routine vaccination for tetanus, diphtheria, and pertussis. Infants and young children are recommended to receive a 5-dose series of diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccines, with one adolescent booster dose of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine. Adults who have never received Tdap also are recommended to receive a booster dose of Tdap. Women are recommended to receive a dose of Tdap during each pregnancy, which should be administered from 27 through 36 weeks’ gestation, regardless of previous receipt of Tdap. After receipt of Tdap, adolescents and adults are recommended to receive a booster tetanus and diphtheria toxoids (Td) vaccine every 10 years to assure ongoing protection against tetanus and diphtheria.

Pertussis (whooping cough)

“…A large British retrospective cohort study using primary care data demonstrated that the benefit of passive maternal immunity did not persist beyond the third dose of primary immunisation in the infant 79. Guidelines from Public Health England26 and Centers for Disease Control and Prevention84 recommend vaccination at 16-32 weeks and 27-36 weeks of gestation respectively. Immunisation in the second trimester may be preferred as it can protect preterm infants, allow more time for maternal antibody transfer, and can logistically be combined with a routine antenatal check 858687.…”

“…An alternative strategy, called “cocooning,” is thought to prevent pertussis indirectly by vaccination of household adolescent and adult family members who may be a source of infection for infants 84. The results have been mixed and do not support the universal implementation of cocooning 93949596.…”

The Prevention of Infections in Older Adults: Vaccination

“…Due to widespread vaccination, tetanus infection is rare in high‐income countries. Older adults, however, have a relatively higher incidence of tetanus and also have a higher mortality rate if they are unfortunate enough to become infected . Between 2001 and 2008 in the United States, only 56.9% of those aged 65 years or older had received a tetanus‐containing vaccine within the recommended 10‐year interval for vaccination .…”

“…Both Td and Tdap vaccines are contraindicated when there is a history of a severe allergic reaction following a prior tetanus vaccine . The Tdap vaccine is also contraindicated if a patient who received a prior dose of Tdap had encephalopathy, not attributable to another etiology, within 7 days of the vaccine being administered . Because this encephalopathy warning is related only to the pertussis component of the vaccine, these patients may receive Td instead .…”

“…In older adults, if the recommended childhood series was not done at all, the recommendation is one dose of Tdap, followed by Td at least 4 weeks later, followed by another dose of Td 6 to 12 months later . In older adults, if the recommended childhood series was not complete, the recommendation is to give one dose of Tdap .…”