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Posted On : 21 Jan 2015

Nowadays, we have been giving Tdap{Boostrixperdacel} at the age of 10years after full course of DTaP . The immune effect of Tdap lasts for about 5 to 8 years. Hence shall we continue Tdap every 5 to 8 years life long. Kindly enlighten me about this vaccination

UPENDRANATH CHINTAWAR

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Answer 1

Diphtheria and pertussis antibody levels acquired by the primary immunization schedule, decrease in 6-12 years. Adolescents and adults are increasingly more susceptible to both the diseases. Studies in developed countries, mainly the USA, have shown that the number of cases of pertussis in adolescents and adults are increasing over the last few years.There is no data on the incidence of adult pertussis in India, but it is estimated to be significant.DTwP, DTaP vaccines cannot be used in children More than 7 years of age due to increased reactogenicity.Hence, Tdap with standard quantity Tetanus Toxoid {5 Lf}, reduced quantity diphtheria {2 Lf} and reduced quantity acellular pertussis {pertussis toxoid 8 microgram, filamentous hemagglutinin 8 microgram, pertactin 2.5 microgram}, has been recommended by the IAP committee on immunization, 2008.

Dose—0.5 ml IM.
Efficacy against clinical disease- More than 90 percent
Side effects—pain, redness, swelling at injection site, fever, headache, fatigue. Serious adverse effects-not known.
Contraindications—anaphylaxis to any of the components, h, o encephalopathy within 7 days of administration of vaccine with pertussis component, not attributable to any other cause.

Cost—Boosterix-Dollar10
Adacel-Dollar40

IAP COI, 2008 Recommendation:
1.In those children who have received primary immunization with DTwP, DTaP, Tdap should be given as a single dose at 10-12 years. Catch up vaccination is recommended till the age of 18 years. A single dose of Tdap can be used in place of Td, TT booster in adults if they have not received Tdap earlier. A gap of at least 5 years is to be maintained between Tdap and previous Td, TT. A gap of 2 years is acceptable if the person is in a high risk situation, i.e. during an outbreak, with neurological, pulmonary disease, in contact with infants Less than 12 months of age.
2.In place of TT, Td in wound management of children aged 10 years and above, if they have not received Tdap earlier.
3.In children who have missed the second booster and are More than 7 years of age, single dose of Tdap can be given.
4.Children More than 7 years and have not completed primary immunization, single dose of Tdap and 2 doses of Td at 0, 1 and 6 months is recommended.
5.Single booster of Tdap can be given in adolescents and adults and repeat boosters of Td at 10 year intervals. There is no data to support repeated doses of Tdap. Austria is the only country where Tdap is recommended every 10 years.

CDC 2010 Recommendations for use of Tdap:
1.Administer at 11 or 12 years for those who have completed recommended childhood DTP, DTaP vaccines, and have not received a Td booster.
2.Those between 13 and 18 years and have not received Tdap, should receive a single dose.
3.5 year interval from last Td dose, when Tdap is used as a booster, shorter interval if immunity against pertussis is needed.
4.Adults—single dose of Tdap if not received earlier, followed by doses of Td if needed.

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