The Tdap vaccine is a booster for pertussis (whooping cough), tetanus, and diphtheria given to all adolescents and to adults caring for a newborn baby, including pregnant women with each pregnancy.
Summary
- Diphtheria is deadly and still common in many parts of the world, with cases in the United States as well.
- Tetanus lives in the soil and anyone who is not immunized is at risk.
- Pertussis is still quite common and is a serious or deadly disease in infants especially. Many cases are still seen in the United States.
- The vaccine has no serious side effects and the risks of the diseases outweigh the risk of the vaccine.
- A tetanus booster is needed every 10 years; everyone is susceptible since the germ lives in the soil. Pertussis is still rather common, especially in teens and young adults. Teens and adults need to be protected themselves, and they also need to be vaccinated to avoid infecting their younger siblings and other children. Adults caring for newborns need the vaccine to avoid giving pertussis to the baby. Pregnant women getting the vaccine will pass antibodies to the baby through the placenta so that the baby is born with some immunity.
- HIGHLY RECOMMENDED
The Tdap vaccine is an updated version of the tetanus booster shot (Td), with pertussis (whooping cough) booster added. Infants and young children receive the primary series of shots as DTaP vaccine, which protects against diphtheria, tetanus (lockjaw), and pertussis (whooping cough). For many years, a tetanus booster has been recommended every 10 years, starting at age 11. Now it is also recommended that a pertussis booster be given at this age, thus the development of the Tdap vaccine. Older children and adults who have not received a pertussis booster should also get one dose of Tdap, then resume the Td shot every 10 years as before.
Pertussis is still a common disease. It is particularly common in teenagers and young adults, including young mothers and fathers. I have seen numerous cases over the years. Unfortunately, infants can catch it before they are fully vaccinated. In older children and adults, the disease causes an annoying cough for a month or two but rarely causes serious disease. In infants, however, it can cause brain damage or death. I have also seen numerous infants with pertussis over the past few years when I worked in children’s hospitals, and we have personal friends who came very close to losing their baby a few years ago due to pertussis.
Immunizing older children should reduce the disease both in adolescents and young adults and in babies as well. There is an effort to vaccinate mothers of infants as well, since a number of infants catch pertussis from their mothers. There is some talk of pediatricians vaccinating mothers, but this is difficult due to problems with the managed care industry. However, in our practice we do offer this vaccine to parents.
Diseases
See DTaP vaccine for a discussion of diphtheria, tetanus, and pertussis.
Schedule
The vaccine is given at age 11-12 years, a tetanus booster (Td) is given once every 10 years thereafter. Older children and adults who have never received Tdap vaccine should receive one dose of Tdap at some point instead of the Td vaccine. From then on, a Td is needed every 10 years. The Tdap vaccine is also recommended for pregnant women at each and every pregnancy, and for family members and caregivers of newborn babies who have never had a dose of Tdap.
How it is given
The vaccine is injected into the upper arm muscle. It is safe and effective to give Tdap along with other vaccines the same day.
Side effects
The vaccine causes few side effects. It may cause some soreness at the injection site for 1-2 days; it can also cause a slight fever.
Risks vs. benefits
The risks of the vaccine are small, with the side effects noted above, and no one has ever died from the vaccine. Diphtheria outbreaks are occurring in other countries when immunization rates fall, and tetanus is a continual possibility since it comes from bacteria living in the soil. Pertussis is still rather common, especially in teenagers and young adults. It can be a mild disease at this age, but it can have some serious effects as well. It is easily transmitted to infants in whom it is usually serious and may be fatal. The benefits of the vaccine far outweigh any possible side effects.
Contraindications
Someone who has had a severe allergic reaction to Tdap vaccine should not get another dose. A child who is moderately or severely ill should probably delay the vaccination until he or she has recovered from the illness.
Combination vaccines
The Tdap vaccine is not used in any combination vaccines.
Brands/manufacturers
Adacel™ (Sanofi-Aventis) is used in children and adults age 11 to 65; it does not contain thimerosal (mercury) as a preservative. Boostrix (GSK) is used in children 10 and up, up to age 18; it does not contain thimerosal.
Resources
Tdap Vaccine Information Statement (VIS)/CDC
References
Updated Tdap Vaccine Recommendations from the ACIP, 2010 MMWR, January 14, 2011, Vol 60, #01
Updated Recommendations for Use of Tdap in Pregnant Women and Persons Who Have or Anticipate Having Close Contact with an Infant Aged <12 Months – ACIP, 2011 MMWR, October 21, 2011, Vol 60, #41
Amirthalingam G et al. Effectiveness of maternal pertussis vaccination in England: An observational study. Lancet 2014 Jul 16. doi:10.1016/S0140-6736(14)60686-3
Sukumaran L, McCarthy NL, Kharbanda EO, et al. Association of Tdap Vaccination With Acute Events and Adverse Birth Outcomes Among Pregnant Women With Prior Tetanus-Containing Immunizations. JAMA. 2015;314(15):1581-1587. doi:10.1001/jama.2015.12790.
Munoz FM, Bond NH, Maccato M, et al. Safety and Immunogenicity of Tetanus Diphtheria and Acellular Pertussis (Tdap) Immunization During Pregnancy in Mothers and Infants: A Randomized Clinical Trial. JAMA. 2014;311(17):1760-1769. doi:10.1001/jama.2014.3633.
Kharbanda EO, Vazquez-Benitez G, Lipkind HS, et al. Evaluation of the Association of Maternal Pertussis Vaccination With Obstetric Events and Birth Outcomes. JAMA. 2014;312(18):1897-1904. doi:10.1001/jama.2014.14825.
Acosta, A.M., DeBolt, C., Tasslimi, A., et al. Tdap Vaccine Effectiveness in Adolescents During the 2012 Washington State Pertussis Epidemic. Pediatrics 135, 981–989. doi:10.1542/peds.2014-3358