These guidelines are based on provisional ACIP recommendations for adults and will be updated once final ACIP recommendations are published in the MMWR.

Pertussis is a highly contagious respiratory tract infection.  Although most children are protected against pertussis by vaccination during childhood, immunity wanes over time and leaves adolescents and adults unprotected.

Two vaccines exist for adolescents and adults that prevent tetanus, diphtheria and pertussis (Tdap).  Both vaccines provide the same protection from tetanus, diphtheria and pertussis, as a single booster dose.

• Boostrix (manufacturer GlaxoSmithKline Biologicals), licensed for adolescents 10-18 years of age.
• Adacel (manufacturer: sanofi pasteur), licensed for adolescents and adults 11-64 years of age.
• Tdap is supplied by the state for children 10-18 years of age.
• Dose for both vaccines: A single dose of Tdap, 0.5 cc IM usually in the upper arm (deltoid) muscle. All Tdap immunizations should be effective approximately four (4) weeks after administration.

Provisional Recommendations for Tdap for Adults

• Tdap for a one time routine booster dose in place of Td (Tetanus/diphtheria) if it has been >10years since last Td.
• Intervals: Tdap may be given at intervals of less than 10 years.  For pertussis prevention the interval may be as short as two years, during an outbreak situation.  
• Adults (parents, grandparents < 65, child care providers, and healthcare providers) in close contact with infants <12 months should receive a single dose of Tdap at least a month prior to contact with infant. An interval of two (2) years or more since the last Td is suggested. Women should receive Tdap in the immediate post-partum period if they have not previously received Tdap.  Women who might become pregnant are encouraged to receive a single dose of Tdap.
• Healthcare personnel: A single dose of Tdap is recommended for any healthcare worker who has direct patient contact (hospital or ambulatory care setting). Priority should be given to healthcare personnel who have direct contact with infants <12months.
• Pregnancy:  Tdap is not recommended for pregnant women at this time. Pregnant women should receive Tdap after delivery, according to the recommendations for vaccinating adults who have direct contact with infants  <12 months.  Pregnant women who have not received the primary three (3) dose vaccination series for tetanus should begin the Td series during pregnancy.  If the Td is indicated during pregnancy, vaccinating during the second or third trimester is preferred when feasible. If Td was received >10 years earlier, Td should be received during pregnancy.
• Incomplete or unknown vaccine history:
• Adults who have never received a dose of Tetanus containing product, should receive a series of three (3) vaccinations.
  • Dose 1- Tdap preferred choice for the first dose.
  • Dose 2- Td is administered at least four weeks after first dose.
  • Dose 3- Td is administered at least 6 to 12 months after second dose.         
• History of Pertussis: Generally should receive Tdap according to routine recommendations as listed above.
• Adults >65 years of age:  Tdap is not licensed for adults age 65 or over.
• Simultaneous administration:  Tdap should be administered with other vaccines at the same visit when possible.  Each vaccine should be administered in a separate syringe at a different anatomic site.

Information for Providers

• Contraindications to Tdap
  • History of serious allergic reaction (i.e., anaphylaxis) to vaccine components
  • History of coma, prolonged seizures (i.e. encephalopathy) not attributable to an identifiable cause within seven (7) days following administration of a pertussis vaccine. (Family history of seizures is not a contraindication.)

• Precautions and reasons to defer Tdap:
  • Guillain-Barre Syndrome (GBS) ¡Ü 6 weeks after a previous dose of a tetanus toxoid-containing vaccine
  • Moderate to severe acute illness
  • Unstable neurological condition (i.e. uncontrolled epileptic seizures with no medication)
  • History of severe local reactions with fever and lethargy due to a tetanus vaccine administered < 10 years previously (Arthus hypersensitivity reaction to tetanus toxoid-containing vaccine)

Reporting Adverse Events after Vaccination:

All clinically significant adverse events following vaccination should be reported to VAERS, even if a causal relationship to vaccination is uncertain. VAERS reporting forms and information are available electronically at http://www.vaers.hhs.gov/ or by calling (800) 822-7967. Providers are encouraged to report electronically at https://secure.vaers.org/VaersDataEntryintro.htm.