AAFP Launches Awareness Campaign for Pertussis Vaccination

Although the CDC estimates that 600,000 cases of pertussis, or whooping cough, occur each year in the United States, only 2 percent of American adults received the tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine, or Tdap, from 2005 through 2007, the agency says.

To address this problem, the AAFP has launched a new initiative, Vaccination Matters: Help Protect Families From Whooping Cough. The first phase of the initiative, which is supported by funding from vaccine manufacturer GlaxoSmithKline, is designed to remind Academy members of the role they play in protecting families from the disease.

"We all know the importance of immunizations for children, but once kids get beyond a certain age, vaccinations tend to fall off our radar screen," AAFP President Ted Epperly, M.D., of Boise, Idaho, told AAFP News Now. "We hope to bring back to members the importance of all immunizations -- in this case, whooping cough."

The Vaccination Matters Web page features a multimedia presentation -- hosted by Epperly -- on select results of an Academy survey of members about their knowledge of and practices related to pertussis and pertussis immunization. Also included are patient information tear sheets, a fact sheet that summarizes results of the survey, and related articles from American Family Physician and Family Practice Management.

A consumer-targeted component of the awareness campaign is scheduled to launch this fall.

Doug Campos-Outcalt, M.D., M.P.A., the AAFP's liaison to the CDC's Advisory Committee on Immunization Practices, or ACIP, and associate head of the department of family and community medicine at the University of Arizona College of Medicine, Phoenix, said Tdap remains a relatively new vaccine and is "not yet in everyone’s thought processes."

Sanofi pasteur's Tdap vaccine, Adacel, was approved by the FDA in June 2005 as a single booster dose in adolescents and adults ages 11-64. GlaxoSmithKline's version of the vaccine, Boostrix, received FDA approval the previous month for use in patients who are 10-18 years of age, an indication that subsequently was expanded to also include individuals ages 19-64 years.

In 2006, the ACIP recommended that adults who are 19-64 years of age receive a single booster dose of Tdap to replace tetanus and diphtheria toxoids vaccine, or Td, if patients received their last dose of Td 10 or more years earlier and have not previously received Tdap.

A recently completed Academy survey indicates that 96 percent of AAFP members were at least "somewhat familiar" with ACIP recommendations (2-page PDF; About PDFs) for the use of Tdap and Td vaccines. However, less than 30 percent of members surveyed said they review the vaccination status of their adult patients more than 75 percent of the time.

"The biggest problem is that physicians often do not think about immunizations during routine visits," said Jonathan Temte, M.D., Ph.D., professor in the department of family medicine at the University of Wisconsin School of Medicine and Public Health, Madison, and a member of the ACIP. "This is made worse by the infrequency of adult vaccinations."

Temte said adults most commonly receive tetanus boosters at urgent care or emergency facilities, which often provide Td, rather than Tdap, vaccine. Another complicating factor, he said, is that many physicians are reluctant to provide Tdap fewer than five to 10 years after a patient last received Td vaccine, despite an ACIP recommendation that intervals shorter than 10 years can be used to provide booster protection against pertussis.

The ACIP recommends that adults with uncertain or incomplete vaccination histories should complete a three-dose series of tetanus and diphtheria toxoid-containing vaccines. Tdap can substitute for any of the three doses.

Temte said all close contacts of infants younger than 6 months old should be immunized with Tdap, as should all health care workers.

"For healthy adults, pertussis is a pain, a prolonged cough that can persist for weeks and months," Temte said. "For older individuals and for infants, pertussis can be life-threatening."

The AAFP's pertussis survey indicates that more than 80 percent of members think the disease is hard to diagnose in adults.

"Pertussis can be hard to detect in adolescents and adults, so often it goes unrecognized," Epperly said. "That's all the more reason for members to be aware of the importance of vaccination so we can prevent this common illness."