Author’s response

I agree that the statement, “The ACIP encourages health care providers to administer a booster dose of Tdap to adolescents aged 11 to 18 years who have already received the recommended Td booster dose so they will be protected against pertussis as well as tetanus and diptheria” is true in a broad sense and further agree that the intervals recommended by the ACIP were not clarified. I appreciate Ms. Lovette’s insightful comments.

Ms. Lovette is correct that, in general, the ACIP recommends a 5-year interval between receiving a Td and the Tdap (ACIP, 2005). The ACIP also suggests, “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 (e.g., pertussis outbreaks and close contact with an infant aged <12 months).” Determining the risk/benefit ratio for a teenager can be incredibly difficult, though. The failure of the hepatitis B risk assessment administration strategy is only one example of the flaw with this methodology. While I would encourage providers to follow the ACIP guidelines, with the amazing rise in the incidence of pertussis, I would also encourage providers to vaccinate adolescents when they are present. Missed opportunities continue to be a major problem in meeting the 2010 objectives.