CDC's Advisory Committee on Immunization Practices, in the Dec. 15 Morbidity and Mortality Weekly Report, advises health care personnel who work in hospitals or ambulatory care settings and have direct patient contact to receive a single dose of the vaccine – which provides immunity against pertussis, tetanus and diphtheria – as soon as feasible if they have not already received it.

The committee also asserts that adults age 19 through 64 should receive a single dose of the vaccine for immunization against tetanus, diphtheria and pertussis to replace their booster shots for tetanus and diphtheria – if they received their last booster shots 10 or more years earlier and have not yet received the new vaccine.

The vaccine recommended by CDC is Adacel, which is a tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine adsorbed (referred to as a "Tdap" in the medical lexicon) manufactured by sanofi pasteur of Toronto – part of the Lyon, France-based sanofi-aventis Group. Adacel – which the Food and Drug Administration licensed on June 10, 2005 – provides protection against pertussis, diphtheria and tetanus for people age 11 through 64. CDC points out that GlaxoSmithKline manufactures a similar vaccine, but it is licensed only for adolescents age 10 through 18.

Pertussis Cases on the Rise

CDC points out that pertussis has been a reportable disease in the United States since 1922. A vaccine was introduced in the late 1940s, reducing the number of reported pertussis cases from an estimated 200,000 annual cases to a low of 1,010 cases reported in 1976.

"Since then, a steady increase in the number of reported cases has occurred," CDC says in the Dec. 15 Morbidity and Mortality Weekly Report. "Reports of cases among adults and adolescents have increased disproportionately. In 2004, 25,827 cases of pertussis were reported to the CDC, the highest number since 1959."

CDC concludes that the availability of Adacel "offers an opportunity to reduce the burden of pertussis in the United States."

Vaccinating Health Care Personnel Has Cost Benefits

CDC explains that health care personnel "are at risk for being exposed to pertussis in inpatient and outpatient pediatric facilities and in adult health care facilities and settings including emergency departments." According to CDC, the options for controlling and investigating pertussis after an outbreak "are labor-intensive, disruptive and costly, particularly when the number of exposed contacts is large."

Vaccinating health care personnel with Adacel and thereby reducing the number of cases of pertussis among health care personnel "will reduce the costs associated with resource-intensive hospital investigations and control measures" such as "case/contact tracking, post-exposure prophylaxis and treatment of hospital-acquired pertussis cases."

Implementation

CDC points out that the infrastructure for screening, administering and tracking vaccinations already is in place in most hospitals and is expected to be adequate for implementing Adacel vaccination programs.

The agency recommends screening and vaccinating new hires when they begin employment. CDC encourages health care facilities to use strategies that have boosted health care workers' participation in previous hospital vaccination campaigns. Such strategies have included:

• Education about the benefits of vaccination;
• Vaccination clinics located in a convenient location for health care personnel; and
• Providing vaccines at no cost to health care personnel.

As for the last point, CDC acknowledges that purchasing and administering Tdap (Adacel) "is an added financial and operational burden for health care facilities," but "a cost-benefit model suggests that the cost of a Tdap vaccination program" is offset by savings brought about by reductions in the costs associated with hospital investigations and control measures as well as improvements in safety for health care professionals and patients.

Recommendations

CDC recommends that:

• Health care personnel who work in hospitals or ambulatory care settings (not including long-term care facilities such as nursing homes) who have direct patient contact should receive a single dose of Adacel as soon as feasible if they have not previously received it.
• Although tetanus/diphtheria booster shoots (referred to as "Td" in medical terminology) routinely are recommended at an interval of 10 years, an interval as short as 2 years from the last Td shot is recommended for the Adacel vaccination among health care personnel.
• Health care personnel who do not work in hospitals or ambulatory care settings or who do not have direct patient contact should receive a single dose of Adacel to replace the next scheduled Td shot (according to the routine recommendation) at an interval no greater than 10 years since the last Td shot. They are encouraged to receive the Adacel dose at an interval as short as 2 years following the last Td shot.
• After receiving an Adacel shot, health care professionals should receive a Td or TT shot for booster immunization against tetanus and diphtheria according to previously published guidelines (because Adacel is not licensed for multiple administrations).

The agency adds that priority should be given to vaccinations of health care professionals who have direct contact with infants under 12 months old and other vulnerable groups of patients.

To view the article "Preventing Tetanus, Diphtheria and Pertussis Among Adults: Use of Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccine," click here.

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