AAFP Joins ANA, Others in Urging Clinicians to Follow New Tdap Recommendations

Immunizing Close Contacts Creates Protective 'Cocoon' for Infants, Say Groups

March 28, 2011 11:20 am News Staff

The AAFP has signed on to a letter(2 page PDF) drafted by the American Nurses Association, or ANA, that supports recent recommendations from the CDC's Advisory Committee on Immunization Practices, or ACIP, for adolescent(5 page PDF) and adult(4 page PDF) pertussis vaccinations.

The Academy joined seven other professional health care organizations -- including the AMA, the American Academy of Pediatrics and the American College of Physicians, -- in signing the ANA letter, which was released March 28.

During its Oct. 27-28, 2010, meeting, the ACIP recommended that children ages 7 through 10 years who did not complete the recommended childhood series of diphtheria and tetanus toxoids and acellular pertussis, or DTaP, vaccine receive a catch-up dose of tetanus, diphtheria and acellular pertussis, or Tdap.

The ACIP also recommended that adults ages 65 and older who have close contact with infants receive a dose of Tdap. A dose also may be given to people in this age group who have not previously received Tdap.

In addition, the updated Tdap recommendations state that the vaccine can be used regardless of the interval since previous immunization with a vaccine that contains tetanus or diphtheria toxoid.

The letter to health care professionals drafted by the ANA urges providers to follow the new recommendations, pointing out that 75 percent to 83 percent of infant pertussis cases with known sources of exposure were attributed to infection by a household member. Parents and siblings are the most common sources, with more than half of infant cases linked to infected parents.

"By being vaccinated, close contacts of infants create a protective 'cocoon' for newborns and infants who either cannot yet be vaccinated or have not completed their initial vaccine series," the ANA's letter says. "Educate the families you care for about why it's important to be up-to-date with Tdap vaccinations and where Tdap can be obtained. Offer Tdap vaccine, especially, to postpartum/breastfeeding women and families, if possible, before discharge from the hospital or birthing center."

Infants are recommended to receive the DTaP primary series at 2, 4, and 6 months of age. The California Department of Public Health(www.cdph.ca.gov) said March 9 that more than 70 percent of known hospitalizations resulting from an ongoing pertussis outbreak in that state have been among infants younger than age 6 months.

California had 9,477 confirmed, probable and suspected cases of pertussis in 2010, and more than 500 cases with onset in 2011 have been reported.

The joint letter also notes that pertussis outbreaks in newborn populations have been linked to infection by health care personnel. The letter urges health care personnel to protect vulnerable patients, calling vaccination "a duty to promote patient safety and public health."

During its Feb. 23-24 meeting, the ACIP voted to bring guidance for health care personnel in line with the pertussis recommendations the committee made for the general population in October.

The new recommendation calls for all health care personnel who have not previously received Tdap to receive a single dose as soon as feasible -- regardless of the interval since their last dose of tetanus and diphtheria toxoids, or Td, vaccine.