The CDC's Advisory Committee on Immunization Practices (ACIP) made a new provisional recommendation during its Feb. 22-23 meeting(www.cdc.gov) in Atlanta that will further alter the way family physicians approach tetanus, diphtheria and acellular pertussis (Tdap) vaccination for older patients.
According to Jamie Loehr, M.D., of Ithaca, N.Y., the AAFP liaison to the CDC's Advisory Committee on Immunization Practices, the influenza season started extremely late this year. As of mid-February, there was a slightly increased number of flu cases in the United States, but the number remains low compared with past years' figures.
In addition, only three pediatric deaths have been reported so far this season versus 122, 282, and 133 in the past three seasons, respectively.
Loehr also noted that although influenza A virus resistance to oseltamivir and zanamivir is virtually nonexistent in the United States, amantadine and rimantidine still have high resistance patterns and are not recommended for use.
For all of these reasons, he said, the CDC is urging physicians to keep vaccinating their patients against the flu.
According to Jamie Loehr, M.D., of Ithaca, N.Y, the AAFP's liaison to the ACIP, the committee voted 14-1 to recommend that adults ages 65 and older should routinely receive one dose of Tdap vaccine if they have not previously received a dose. The Tdap dose would replace one booster dose of tetanus and diphtheria toxoids vaccine (Td).
Loehr also noted that the new provisional recommendation removed the suggestion that Tdap be given when a patient is regularly scheduled to receive his or her 10-year tetanus booster. Instead, Tdap may be given at the next available opportunity, no matter how much or how little time has expired since the previous Td vaccine dose was given.
"Overall, the information presented suggested that the vaccine is safe and immunogenic, that the disease incidence is much higher than currently reported, and that there is a high burden of disease in the elderly," Loehr said. "Thus, it was felt to be reasonable to extend the routine recommendation for Tdap to those 65 and older."
Loehr added that the group also discussed how to recommend between the two versions of Tdap available in the U.S. market -- GlaxoSmithKline's Boostrix, which is approved for use as a booster in people ages 10 years and older, and Sanofi Pasteur's Adacel, which is indicated as a booster in people ages 11-64 years. Whereas Boostrix is specifically FDA-approved for use in adults 65 and older, Adacel is licensed -- but not approved -- for use in this age group because the vaccine did not meet its predefined noninferiority criteria in the data it submitted to the FDA.
"The ACIP felt that the preference would be for Boostrix to be given to the elderly, if available," Loehr noted. "However, providers should not miss an opportunity to vaccinate if the only Tdap vaccine available is Adacel, and both vaccines should be considered valid, if given."