Letter to the Editor

Article Outline

• Copyright

DEAR EDITOR:

I was reading the article “Update on Adolescent Immunization: Review of Pertussis and the Efficacy, Safety, and Clinical Use of Vaccines That Contain Tetanus-Diptheria-Acellular Pertussis” in the Journal of Pediatric Health Care July/August 2006 edition. There is a statement in the article: “The [Advisory Committee on Immunization Practices (ACIP)] encourages health care providers to administer a booster dose of [tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap)] to adolescents aged 11–18 years who have already received the recommended Td booster dose so they will be protected against pertussis as well as tetanus and diphtheria” (p.235). While this statement is true in a broad and general sense, I believe it may be misleading. If a child has received the Td booster at the 11- to 12-year visit, then they should wait 5 years to have the Tdap booster unless there is an outbreak of pertussis, in which case they could receive the Tdap at an interval of 2 years. ACIP recommends that adolescents aged 11–18 years who received Td, but not Tdap, are encouraged to receive a single dose of Tdap to provide protection against pertussis if they have completed the recommended childhood diphtheria/tetanus/pertussis and diphtheria/tetanus and acellular pertussis (DTP/DTaP) vaccination series. An interval of at least 5 years between Td and Tdap is encouraged to reduce the risk for local and systemic reactions after Tdap vaccination. However, an interval less than 5 years between Td and Tdap can be used … and vaccine providers can administer Tdap to adolescents aged 11–18 years at an interval less than 5 years after Td, particularly when the benefit of providing protection against pertussis is likely to be increased. The safety of an interval as short as approximately 2 years between Td and Tdap is supported by a Canadian study among children and adolescents.

I don’t mean to nitpick, but the statement as it was written kind of startled me and made me look back at the recommendations to be sure I was correct in my thinking that you should not give Tdap at the next visit if the adolescent already received their Td booster at the 11- to 12-year well child check.