Cases of Pertussis on the Rise

Despite the use of pertussis-containing childhood vaccines, cases of pertussis have been on the rise in many communities nationwide, with an increasing burden of disease reported among adolescents and adults. In 2008 there were over 13,000 cases and 20 deaths reported to CDC.

In 2005, the Advisory Committee on Immunization Practices, or ACIP, recommended a dose of a combination tetanus, diphtheria and pertussis vaccine -- or Tdap -- for use in 11 through 64 year olds.

There are currently 2 licensed products that can be used. Because immunity from childhood pertussis vaccination wanes over time, this booster shot for adolescents and adults is essential. Boosting reduces the risk of contracting pertussis and can decrease severity of disease. Most importantly, vaccinating adolescents and adults can help prevent pertussis transmission to infants too young to be vaccinated. This youngest age group is most vulnerable to severe disease and death from pertussis.

Even though Tdap has been recommended since 2005, coverage rates are not as high as we'd like them to be. Among adolescents who are 13 though 17 years of age, coverage was estimated at 40% in 2008. Among adults, it was less than 6%.

Here are the key recommendations for using Tdap:

• Among adolescents who have completed their childhood pertussis vaccinations, Tdap is routinely recommended as a single dose with preferred administration at 11 to 12 years of age.
• If your adolescent patient was not fully vaccinated for pertussis as a child, check the ACIP recommendations and catch-up schedule to determine what's indicated. Those resources are linked below
• Any adult 19 through 64 years old who has not received a dose of Tdap should get one. This can replace 1 of the 10-year Td booster doses.

However, it's not necessary to wait the typical 10 years to get the adult dose of Tdap after the last dose of Td. An interval as short as 2 years from the last Td is suggested to reduce likelihood of increased reactogenicity.

Even shorter intervals may be appropriate if your patient is at high risk for contracting pertussis or has close contact with infants, or in situations where you might not get a chance to vaccinate the patient again. Providers should know that shorter intervals are not contraindicated and accumulating data reinforce safety of the vaccine. Furthermore, there are no concerns about immunogenicity with this decreased interval between Td and Tdap administration.

To help protect infants too young to be vaccinated, women should ideally receive Tdap before becoming pregnant. If a pregnant woman is at increased risk for contracting pertussis, such as during a community outbreak, you may want to consider Tdap during pregnancy since it's not contraindicated. New moms who have not received Tdap should routinely receive a dose immediately postpartum, before leaving the hospital or birthing center.

In most cases, pertussis in infants is acquired from a family member. Imagine how devastating it would be for a mom to give her baby pertussis. Keep in mind that Tdap is not just for postpartum moms, it's for all family members and caregivers of the infant.

Also, healthcare providers who have direct patient contact should receive a single dose of Tdap as soon as feasible if they have not previously received it.