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DOD Medical Materiel Quality Control Messages (MMQC)/Medical Materiel Information Messages (MMI) & Images

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Q111074
FROM
QUAD SERVICE MMQC FT DETRICK MD//USAMMA/AFMLO/NMLC//
 
***PRIORITY***MESSAGE RELEASED:
02/02/2011
 
****************UNCLASSIFIED****************
 
SUBJ: MMQC-11-1074
UPDATED
RECOMMENDATIONS FOR USE OF TETANUS TOXOID, REDUCED DIPHTHERIA TOXOID AND ACELLULAR PERTUSSIS
(TDAP) VACCINE FROM THE ADVISORY COMMITTEE ON IMMUNIZATION PRACTICES, 2010
 
 
01. EXCERPT
FROM CENTERS FOR DISEASE CONTROL AND PREVENTION. MORBIDITY AND 
MORTALITY WEEKLY REPORT
(MMWR).

DESPITE SUSTAINED HIGH COVERAGE FOR CHILDHOOD PERTUSSIS VACCINATION, PERTUSSIS
REMAINS POORLY CONTROLLED IN THE UNITED STATES. A TOTAL OF 16,858 PERTUSSIS 
CASES AND 12
INFANT DEATHS WERE REPORTED IN 2009 (1; CDC, UNPUBLISHED DATA, 
2009). ALTHOUGH 2005
RECOMMENDATIONS BY THE ADVISORY COMMITTEE ON IMMUNIZATION 
PRACTICES (ACIP) CALLED FOR
VACCINATION WITH TETANUS TOXOID, REDUCED DIPHTHERIA 
TOXOID AND ACELLULAR PERTUSSIS (TDAP) FOR
ADOLESCENTS AND ADULTS TO IMPROVE 
IMMUNITY AGAINST PERTUSSIS, TDAP COVERAGE IS 56% AMONG
ADOLESCENTS AND <6% 
AMONG ADULTS (2,3). IN OCTOBER 2010, ACIP RECOMMENDED EXPANDED USE OF
TDAP. 
THIS REPORT PROVIDES THE UPDATED RECOMMENDATIONS, SUMMARIZES THE SAFETY AND
EFFECTIVENESS DATA CONSIDERED BY ACIP, AND PROVIDES GUIDANCE FOR IMPLEMENTING 
THE
RECOMMENDATIONS.

ACIP RECOMMENDS A SINGLE TDAP DOSE FOR PERSONS AGED 11 THROUGH 18 YEARS WHO
HAVE COMPLETED THE RECOMMENDED CHILDHOOD DIPHTHERIA AND TETANUS TOXOIDS AND
PERTUSSIS/DIPHTHERIA AND TETANUS TOXOIDS AND ACELLULAR PERTUSSIS (DTP/DTAP) 
VACCINATION
SERIES AND FOR ADULTS AGED 19 THROUGH 64 YEARS (4,5). TWO TDAP 
VACCINES ARE AVAILABLE IN THE
UNITED STATES. BOOSTRIX (GLAXOSMITHKLINE BIOLOGICALS, 
RIXENSART, BELGIUM) IS LICENSED FOR USE
IN PERSONS AGED 10 THROUGH 64 YEARS, 
AND ADACEL (SANOFI PASTEUR, TORONTO, CANADA) IS LICENSED
FOR USE IN PERSONS 
AGED 11 THROUGH 64 YEARS. BOTH TDAP PRODUCTS ARE LICENSED FOR USE AT AN
INTERVAL 
OF AT LEAST 5 YEARS BETWEEN THE TETANUS AND DIPHTHERIA TOXOIDS (TD) AND TDAP 
DOSE.
ON OCTOBER 27, 2010, ACIP APPROVED THE FOLLOWING ADDITIONAL RECOMMENDATIONS: 
1) USE OF TDAP
REGARDLESS OF INTERVAL SINCE THE LAST TETANUS- OR DIPHTHERIA-TOXOID 
CONTAINING VACCINE, 2)
USE OF TDAP IN CERTAIN ADULTS AGED 65 YEARS AND OLDER, 
AND 3) USE OF TDAP IN UNDERVACCINATED
CHILDREN AGED 7 THROUGH 10 YEARS.

THE PERTUSSIS VACCINES WORKING GROUP OF ACIP REVIEWED
PUBLISHED AND UNPUBLISHED 
TDAP IMMUNOGENICITY AND SAFETY DATA FROM CLINICAL TRIALS AND
OBSERVATIONAL 
STUDIES ON USE OF TDAP. THE WORKING GROUP ALSO CONSIDERED THE EPIDEMIOLOGY 
OF
PERTUSSIS, PROVIDER AND PROGRAM FEEDBACK, AND DATA ON THE BARRIERS TO RECEIPT 
OF TDAP. THE
WORKING GROUP THEN PRESENTED POLICY OPTIONS FOR CONSIDERATION 
TO THE FULL ACIP. THESE
ADDITIONAL RECOMMENDATIONS ARE INTENDED TO REMOVE
IDENTIFIED BARRIERS AND PROGRAMMATIC GAPS
THAT CONTRIBUTE TO SUBOPTIMAL VACCINATION 
COVERAGE. AN IMPORTANT BARRIER THAT LIMITED
VACCINATION OF PERSONS WITH TDAP 
WAS UNKNOWN HISTORY OF TD BOOSTER. PROGRAMMATIC GAPS
INCLUDED LACK OF A LICENSED 
TDAP VACCINE FOR CHILDREN AGED 7 THROUGH 10 YEARS AND ADULTS AGED
65 YEARS 
AND OLDER. IN LIGHT OF THE RECENT INCREASE OF PERTUSSIS IN THE UNITED STATES, 
THE
ADDITIONAL RECOMMENDATIONS ARE MADE TO FACILITATE USE OF TDAP TO REDUCE 
THE BURDEN OF DISEASE
AND RISK FOR TRANSMISSION TO INFANTS (BOX).

TIMING OF TDAP FOLLOWING TD

SAFETY. WHEN TDAP
WAS LICENSED IN 2005, THE SAFETY OF ADMINISTERING A BOOSTER 
DOSE OF TDAP AT INTERVALS <5
YEARS AFTER TD OR PEDIATRIC DTP/DTAP HAD NOT BEEN 
STUDIED IN ADULTS. HOWEVER, EVALUATIONS IN
CHILDREN AND ADOLESCENTS SUGGESTED 
THAT THE SAFETY OF INTERVALS AS SHORT AS 18 MONTHS WAS
ACCEPTABLE (6). RATES 
OF LOCAL AND SYSTEMIC REACTIONS AFTER TDAP VACCINATION IN ADULTS WERE
LOWER 
THAN OR COMPARABLE TO RATES IN ADOLESCENTS DURING U.S. PRELICENSURE TRIALS;
THEREFORE, THE SAFETY OF USING INTERVALS AS SHORT AS 2 YEARS BETWEEN TD AND 
TDAP IN ADULTS
WAS INFERRED (4).

ADDITIONAL DATA ON THE SAFETY OF ADMINISTERING TDAP <5 YEARS AFTER TD ARE
NOW 
AVAILABLE. TWO STUDIES WERE CONDUCTED WITH 387 PERSONS AGED 18 THROUGH 76 YEARS 
WHO
RECEIVED A TDAP OR COMBINED TDAP-INACTIVATED POLIO VACCINE (TDAP-IPV)
VACCINATION EITHER
WITHIN 21 DAYS, OR <2 YEARS FOLLOWING A PREVIOUS TD-CONTAINING 
VACCINE (7,8). TDAP-IPV
VACCINE IS NOT LICENSED IN THE UNITED STATES. IN BOTH 
STUDIES, IMMEDIATE OR SHORT-TERM
ADVERSE EVENTS (E.G., 30 MINUTES TO 2 WEEKS) 
AFTER RECEIPT OF TDAP OR TDAP-IPV WERE EXAMINED.
THE MAJORITY OF THESE EVENTS 
WERE LIMITED TO LOCAL REACTIONS, INCLUDING PAIN (68%--83%),
ERYTHEMA (20%--25%), 
AND SWELLING (19%--38%) (7,8). SERIOUS ADVERSE EVENTS RELATED TO THE
RECEIPT 
OF TDAP OR TDAP-IPV SHORTLY AFTER TD OR TD-IPV VACCINATIONS DID NOT OCCUR. 
HOWEVER,
THE NUMBER OF SUBJECTS IN THESE STUDIES WAS SMALL AND DOES NOT EXCLUDE 
THE POTENTIAL FOR
RARE, BUT SERIOUS, ADVERSE EVENTS.

GUIDANCE FOR USE. ACIP RECOMMENDS THAT PERTUSSIS
VACCINATION, WHEN INDICATED, 
SHOULD NOT BE DELAYED AND THAT TDAP SHOULD BE ADMINISTERED
REGARDLESS OF INTERVAL 
SINCE THE LAST TETANUS OR DIPHTHERIA TOXOID-CONTAINING VACCINE. ACIP
CONCLUDED 
THAT WHILE LONGER INTERVALS BETWEEN TD AND TDAP VACCINATION COULD DECREASE 
THE
OCCURRENCE OF LOCAL REACTIONS, THE BENEFITS OF PROTECTION AGAINST PERTUSSIS 
OUTWEIGH THE
POTENTIAL RISK FOR ADVERSE EVENTS.

ADULTS AGED 65 YEARS AND OLDER

UNPUBLISHED DATA FROM
TRIALS FOR ADACEL (N = 1,170) AND BOOSTRIX (N = 1,104) 
ON THE SAFETY AND IMMUNOGENICITY OF
TDAP IN ADULTS AGED 65 YEARS AND OLDER 
WHO RECEIVED VACCINE WERE PROVIDED TO ACIP BY SANOFI
PASTEUR AND GLAXOSMITHKLINE.

SAFETY. FOR BOTH TDAP VACCINES, THE FREQUENCY AND SEVERITY OF
ADVERSE EVENTS 
IN PERSONS AGED 65 YEARS AND OLDER WERE COMPARABLE TO THOSE IN PERSONS AGED
LESS THAN 65 YEARS. NO INCREASE IN LOCAL OR GENERALIZED REACTIONS IN TDAP
RECIPIENTS WAS
OBSERVED, COMPARED WITH PERSONS WHO RECEIVED TD. NO SERIOUS 
ADVERSE EVENTS WERE CONSIDERED
RELATED TO VACCINATION.

ACIP REVIEWED DATA ON VACCINE-RELATED ADVERSE EVENTS FROM THE
VACCINE ADVERSE 
EVENT REPORTING SYSTEM (VAERS). VAERS IS A PASSIVE SURVEILLANCE SYSTEM
JOINTLY 
ADMINISTERED BY CDC AND THE FOOD AND DRUG ADMINISTRATION THAT ACCEPTS REPORTS 
FROM
VACCINE MANUFACTURERS, HEALTH-CARE PROVIDERS, AND VACCINE RECIPIENTS FOR 
VACCINE SAFETY.
VAERS CAN BE PRONE TO OVERREPORTING OR UNDERREPORTING AND
INCONSISTENCY IN THE QUALITY AND
COMPLETENESS OF REPORTS. DURING SEPTEMBER 
2005--SEPTEMBER 2010, A TOTAL OF 243 VAERS REPORTS
WERE RECEIVED REGARDING 
ADULTS AGED 65 YEARS AND OLDER ADMINISTERED TDAP, OUT OF 10,981 TOTAL
VAERS 
REPORTS ON TDAP AMONG RECIPIENTS OF ALL AGES (CDC, UNPUBLISHED DATA, 2010). 
OF THE
243 REPORTS REGARDING ADULTS AGED 65 YEARS AND OLDER, 232 (96%) WERE 
NONSERIOUS. THE MOST
FREQUENT ADVERSE EVENTS AFTER TDAP WERE LOCAL REACTIONS, 
COMPRISING 37% OF ALL EVENTS. ELEVEN
SERIOUS EVENTS WERE REPORTED, INCLUDING 
TWO DEATHS AMONG PERSONS WITH MULTIPLE UNDERLYING
CONDITIONS. ALTHOUGH VAERS 
CANNOT ASSESS CAUSALITY, AFTER REVIEW OF DATA, IT IS UNLIKELY THE
DEATHS WERE 
RELATED TO VACCINE RECEIPT. POSTMARKETING VAERS DATA ALSO SUGGEST THAT TDAP
VACCINE SAFETY IN ADULTS AGED 65 YEARS AND OLDER IS COMPARABLE TO THAT OF TD 
VACCINE. BECAUSE
TDAP IS NOT LICENSED FOR USE IN THIS AGE GROUP, COMPARISONS 
BETWEEN THESE REPORTS AND OTHER
REPORTS NEED TO BE INTERPRETED WITH CAUTION.

IMMUNOGENICITY. BOTH TDAP VACCINES SHOWED THAT
IMMUNE RESPONSES TO DIPHTHERIA 
AND TETANUS TOXOIDS WERE NONINFERIOR TO RESPONSES PRODUCED BY
TD. IN BOTH TDAP 
VACCINES, IMMUNE RESPONSES WERE OBSERVED TO THE PERTUSSIS ANTIGENS. FOR
BOOSTRIX, 
IMMUNE RESPONSES TO PERTUSSIS ANTIGENS (PERTUSSIS TOXIN [PT], FILAMENTOUS
HEMAGGLUTININ [FHA], AND PERTACTIN [PRN]) WERE NONINFERIOR TO THOSE OBSERVED 
FOLLOWING A
3-DOSE PRIMARY PERTUSSIS VACCINATION SERIES, AS DEFINED BY THE 
VACCINES AND RELATED
BIOLOGICAL PRODUCTS ADVISORY COMMITTEE (VRBPAC) (9). FOR 
ADACEL, IMMUNE RESPONSES TO ALL
PERTUSSIS ANTIGENS (PT, FHA, PRN, AND FIMBRIAE 
[FIM]) OCCURRED (4.1 TO 15.1-FOLD GEOMETRIC
MEAN CONCENTRATION INCREASES). 
ACIP CONCLUDED THAT BOTH TDAP VACCINES WOULD PROVIDE PERTUSSIS
PROTECTION IN 
PERSONS AGED 65 YEARS AND OLDER.

GUIDANCE FOR USE. ACIP RECOMMENDS THAT
ADULTS AGED 65 YEARS AND OLDER (E.G., 
GRANDPARENTS, CHILD-CARE PROVIDERS, AND HEALTH-CARE
PRACTITIONERS) WHO HAVE 
OR WHO ANTICIPATE HAVING CLOSE CONTACT WITH AN INFANT LESS THAN 12
MONTHS OF 
AGE AND WHO PREVIOUSLY HAVE NOT RECEIVED TDAP SHOULD RECEIVE A SINGLE DOSE 
OF
TDAP TO PROTECT AGAINST PERTUSSIS AND REDUCE THE LIKELIHOOD OF TRANSMISSION. 
FOR OTHER ADULTS
AGED 65 YEARS AND OLDER, A SINGLE DOSE OF TDAP VACCINE MAY 
BE GIVEN INSTEAD OF TD VACCINE, IN
PERSONS WHO HAVE NOT PREVIOUSLY RECEIVED 
TDAP. TDAP CAN BE ADMINISTERED REGARDLESS OF
INTERVAL SINCE THE LAST TETANUS- 
OR DIPHTHERIA-TOXOID CONTAINING VACCINE. AFTER RECEIPT OF
TDAP, PERSONS SHOULD 
CONTINUE TO RECEIVE TD FOR ROUTINE BOOSTER IMMUNIZATION AGAINST TETANUS
AND 
DIPHTHERIA, ACCORDING TO PREVIOUSLY PUBLISHED GUIDELINES (4). EITHER TDAP VACCINE
PRODUCT MAY BE USED. FURTHER RECOMMENDATIONS ON THE USE OF BOTH TDAP VACCINES 
IN ADULTS AGED
65 YEARS AND OLDER WILL BE FORTHCOMING SHOULD ONE OR MORE TDAP 
PRODUCTS BE LICENSED FOR USE
IN THIS AGE GROUP.

UNDERVACCINATED CHILDREN AGED 7 THROUGH 10 YEARS

NO DATA HAVE BEEN
PUBLISHED REGARDING THE SAFETY OR IMMUNOGENICITY OF TDAP 
IN CHILDREN AGED 7 THROUGH 10 YEARS
WHO HAVE NEVER RECEIVED PERTUSSIS-CONTAINING 
VACCINES. ONE PUBLISHED STUDY ASSESSED THE USE
OF TDAP-IPV VACCINE AS THE FIFTH 
DOSE OF ACELLULAR PERTUSSIS VACCINE IN CHILDREN AGED 4
THROUGH 8 YEARS (10). 
A SUBANALYSIS OF THE STUDY DATA COMPARING SAFETY AND IMMUNOGENICITY
RESULTS 
AMONG CHILDREN AGED 4 THROUGH 6 YEARS (N = 703) AND 7 THROUGH 8 YEARS (N = 
118) WAS
PROVIDED TO ACIP BY GLAXOSMITHKLINE. THREE ADDITIONAL PUBLISHED STUDIES 
HAVE ASSESSED USE OF
TDAP IN LIEU OF THE FIFTH DTAP DOSE IN CHILDREN AGED 4 
THROUGH 6 YEARS WHO HAD RECEIVED 4
PREVIOUS DOSES OF DTAP (11--13). THESE THREE 
STUDIES ENROLLED 609 SUBJECTS WHO RECEIVED
EITHER TDAP OR TDAP-IPV IN LIEU 
OF THE FIFTH DTAP DOSE.

SAFETY. IN EACH STUDY, NO INCREASE
IN RISK OF SEVERE LOCAL REACTIONS OR SYSTEMIC 
ADVERSE EVENTS WAS OBSERVED. THE MOST COMMONLY
REPORTED ADVERSE EVENTS WITHIN 
15 DAYS AFTER RECEIPT OF TDAP WERE PAIN (40%--56%), ERYTHEMA
(34%--53%), AND 
SWELLING (24%--45%). FEWER LOCAL REACTIONS WERE OBSERVED OR REPORTED AMONG
TDAP OR TDAP-IPV RECIPIENTS COMPARED WITH THOSE WHO RECEIVED DTAP OR DTAP-IPV, 
BUT THE
DIFFERENCES WERE NOT STATISTICALLY SIGNIFICANT. NO DIFFERENCES WERE 
NOTED WHEN CHILDREN AGED
4 THROUGH 6 AND 7 THROUGH 8 YEARS WERE COMPARED WITH 
RESPECT TO SOLICITED OR UNSOLICITED
ADVERSE REACTIONS FOLLOWING VACCINATION 
WITH TDAP-IPV. ACIP CONCLUDED THAT THE OVERALL SAFETY
OF TDAP AND FREQUENCY 
OF LOCAL REACTIONS IN UNDERVACCINATED CHILDREN LIKELY WOULD BE SIMILAR
TO THOSE 
OBSERVED IN CHILDREN WHO RECEIVED 4 DOSES OF DTAP.

IMMUNOGENICITY. IMMUNE
RESPONSE TO TDAP-IPV WAS COMPARABLE BETWEEN CHILDREN 
AGED 4 THROUGH 6 AND THOSE AGED 7
THROUGH 8 YEARS, ACCORDING TO THE GLAXOSMITHKLINE 
SUBANALYSIS. IN BOTH AGE GROUPS, AT LEAST
99.9% OF TDAP-IPV RECIPIENTS HAD 
SEROPROTECTIVE LEVELS OF ANTIBODIES FOR DIPHTHERIA AND
TETANUS, AND RESPONSES 
TO PERTUSSIS ANTIGENS WERE COMPARABLE TO THOSE OBSERVED FOLLOWING A
3-DOSE 
PRIMARY PERTUSSIS VACCINATION SERIES AS DEFINED BY VRBPAC.

IN CHILDREN AGED 4
THROUGH 6 YEARS, THE IMMUNE RESPONSE FOLLOWING RECEIPT OF 
TDAP (BOOSTRIX OR ADACEL) WAS
COMPARABLE TO DTAP OR DTAP-IPV (11,12). ALL SUBJECTS 
HAD SEROPROTECTIVE ANTIBODY LEVELS FOR
DIPHTHERIA AND TETANUS 4 TO 6 WEEKS 
AFTER VACCINATION. FOR PERTUSSIS ANTIGENS, ONE STUDY
OBSERVED NO SIGNIFICANT 
DIFFERENCE BETWEEN BOOSTRIX AND DTAP RECIPIENTS IN RESPONSE RATES TO
ANY OF 
THREE PERTUSSIS ANTIGENS IN THE VACCINES, WITH SIMILAR EFFECTS ON CELL-MEDIATED
IMMUNE RESPONSES 3.5 YEARS AFTER VACCINATION (12). ANOTHER STUDY DEMONSTRATED 
A FOURFOLD
INCREASE IN FOUR PERTUSSIS ANTIBODIES IN THE MAJORITY OF CHILDREN 
RECEIVING ADACEL OR
DTAP-IPV (11).

GUIDANCE FOR USE. ACIP RECOMMENDS THAT CHILDREN AGED 7 THROUGH 10 YEARS WHO
ARE NOT FULLY VACCINATED* AGAINST PERTUSSIS AND FOR WHOM NO CONTRAINDICATION 
TO PERTUSSIS
VACCINE EXISTS SHOULD RECEIVE A SINGLE DOSE OF TDAP TO PROVIDE 
PROTECTION AGAINST PERTUSSIS.
IF ADDITIONAL DOSES OF TETANUS AND DIPHTHERIA 
TOXOID--CONTAINING VACCINES ARE NEEDED, THEN
CHILDREN AGED 7 THROUGH 10 YEARS 
SHOULD BE VACCINATED ACCORDING TO CATCH-UP GUIDANCE, WITH
TDAP PREFERRED AS 
THE FIRST DOSE (5). TDAP IS RECOMMENDED IN THIS AGE GROUP BECAUSE OF ITS
REDUCED 
ANTIGEN CONTENT COMPARED WITH DTAP, RESULTING IN REDUCED REACTOGENICITY. CURRENTLY,
TDAP IS RECOMMENDED ONLY FOR A SINGLE DOSE ACROSS ALL AGE GROUPS. FURTHER GUIDANCE 
WILL BE
FORTHCOMING ON TIMING OF REVACCINATION IN PERSONS WHO HAVE RECEIVED 
TDAP PREVIOUSLY.
REFERENCES:

(1).  CDC. FINAL 2009 REPORTS OF NATIONALLY NOTIFIABLE DISEASES. MMWR
2010;59;1025,1027--39. 

(2).  CDC. NATIONAL, STATE, AND LOCAL AREA VACCINATION COVERAGE
AMONG ADOLESCENTS 
AGED 13--17 YEARS---UNITED STATES, 2009. MMWR 2010;59;1018--23. 

(3).
CDC. TETANUS AND PERTUSSIS VACCINATION COVERAGE AMONG ADULTS AGED =18 
YEARS---UNITED STATES,
1999 AND 2008. MMWR 2010;59:1302--6.
 
(4).  CDC. PREVENTING TETANUS, DIPHTHERIA, AND
PERTUSSIS AMONG ADULTS: USE 
OF TETANUS TOXOID, REDUCED DIPHTHERIA TOXOID AND ACELLULAR
PERTUSSIS VACCINE. 
RECOMMENDATIONS OF THE ADVISORY COMMITTEE ON IMMUNIZATION PRACTICES (ACIP)
AND RECOMMENDATION OF ACIP, SUPPORTED BY THE HEALTHCARE INFECTION CONTROL PRACTICES
ADVISORY COMMITTEE (HICPAC), FOR USE OF TDAP AMONG HEALTH-CARE PERSONNEL. MMWR 
2006;55(NO.
RR-17). 

(5).  CDC. PREVENTING TETANUS, DIPHTHERIA, AND PERTUSSIS AMONG ADOLESCENTS: 
USE
OF TETANUS TOXOID, REDUCED DIPHTHERIA TOXOID AND ACELLULAR PERTUSSIS VACCINES.
RECOMMENDATIONS OF THE ADVISORY COMMITTEE ON IMMUNIZATION PRACTICES (ACIP). 
MMWR 2006;55(NO.
RR-3). 

(6).  HALPERIN SA, SWEET L, BAXENDALE D, ET AL. HOW SOON AFTER A PRIOR
TETANUS-DIPHTHERIA VACCINATION CAN ONE GIVE ADULT FORMULATION
TETANUS-DIPHTHERIA-ACELLULAR
PERTUSSIS VACCINE? PEDIATR INFECT DIS J 2006;2
5:195--200.
 
(7).  BEYTOUT J, LAUNAY O,
GUISO N, ET AL. SAFETY OF TDAP-IPV GIVEN ONE MONTH 
AFTER TD-IPV BOOSTER IN HEALTHY YOUNG
ADULTS: A PLACEBO-CONTROLLED TRIAL. HUM 
VACCIN 2009;5:315--21. 

(8).  TALBOT EA, BROWN KH,
KIRKLAND KB, BAUGHMAN AL, HALPERIN SA, BRODER KP. 
THE SAFETY OF IMMUNIZING WITH
TETANUS-DIPHTHERIA-ACELLULAR PERTUSSIS VACCINE 
(TDAP) LESS THAN 2 YEARS FOLLOWING PREVIOUS
TETANUS VACCINATION: EXPERIENCE 
DURING A MASS VACCINATION CAMPAIGN OF HEALTHCARE PERSONNEL
DURING A RESPIRATORY 
ILLNESS OUTBREAK. VACCINE 2010;28:8001--7. 

(9).  FOOD AND DRUG
ADMINISTRATION. VACCINES AND RELATED BIOLOGICAL PRODUCTS 
ADVISORY COMMITTEE. DAY ONE.
BETHESDA, MD: FOOD AND DRUG ADMINISTRATION. AVAILABLE 
AT
HTTP://WWW.FDA.GOV/OHRMS/DOCKETS/AC/97/TRANSCPT/3300T1.PDF. ACCESSED JANUARY 
10, 2011.
(10).  S´┐ŻNGER R, BEHRE U, KRAUSE KH, ET AL. BOOSTER VACCINATION AND 1-YEAR 
FOLLOW-UP OF
4-8-YEAR-OLD CHILDREN WITH A REDUCED-ANTIGEN-CONTENT DTPA-IPV 
VACCINE. EUR J PEDIATR
2007;166:1229--36.
 
(11).  LANGLEY JM, PREDY G, GUASPARINI R, ET AL. AN ADOLESCENT-ADULT
FORMULATION 
TETANUS AND DIPHTHERIA TOXOIDS ADSORBED COMBINED WITH ACELLULAR PERTUSSIS VACCINE
HAS COMPARABLE IMMUNOGENICITY BUT LESS REACTOGENICITY IN CHILDREN 4-6 YEARS 
OF AGE THAN A
PEDIATRIC FORMULATION ACELLULAR PERTUSSIS VACCINE AND DIPHTHERIA 
AND TETANUS TOXOIDS ADSORBED
COMBINED WITH INACTIVATED POLIOMYELITIS VACCINE. 
VACCINE 2007;25:1121--5. 

(12).  MEYER
CU, HABERMEHL P, KNUF M, HOET B, WOLTER J, ZEPP F. IMMUNOGENICITY 
AND REACTOGENICITY OF
ACELLULAR PERTUSSIS BOOSTER VACCINES IN CHILDREN: STANDARD 
PEDIATRIC VERSUS A REDUCED-ANTIGEN
CONTENT FORMULATION. HUM VACCIN 2008;4:203--9. 

(13).  SCHEIFELE DW, HALPERIN SA, OCHNIO JJ,
FERGUSON AC, SKOWRONSKI DM. A 
MODIFIED VACCINE REDUCES THE RATE OF LARGE INJECTION SITE
REACTIONS TO THE 
PRESCHOOL BOOSTER DOSE OF DIPHTHERIA-TETANUS-ACELLULAR PERTUSSIS VACCINE:
RESULTS 
OF A RANDOMIZED, CONTROLLED TRIAL. PEDIATR INFECT DIS J 2005;24:1059--66.

BOX.
SUMMARY OF UPDATED RECOMMENDATIONS FOR USE OF TETANUS TOXOID, REDUCED 
DIPHTHERIA TOXOID AND
ACELLULAR PERTUSSIS (TDAP) VACCINE --- ADVISORY COMMITTEE 
ON IMMUNIZATION PRACTICES, 2010
GENERAL RECOMMENDATIONS

FOR ROUTINE USE, ADOLESCENTS AGED 11 THROUGH 18 YEARS WHO HAVE
COMPLETED THE 
RECOMMENDED CHILDHOOD DIPHTHERIA AND TETANUS TOXOIDS AND PERTUSSIS/DIPHTHERIA
AND TETANUS TOXOIDS AND ACELLULAR PERTUSSIS (DTP/DTAP) VACCINATION SERIES AND 
ADULTS AGED 19
THROUGH 64 YEARS SHOULD RECEIVE A SINGLE DOSE OF TDAP. ADOLESCENTS 
SHOULD PREFERABLY RECEIVE
TDAP AT THE 11 TO 12 YEAR-OLD PREVENTIVE HEALTH-CARE 
VISIT.

TIMING OF TDAP

  -  CAN BE
ADMINISTERED REGARDLESS OF INTERVAL SINCE THE LAST TETANUS- OR 
DIPHTHERIA-TOXOID CONTAINING
VACCINE.

ADULTS AGED 65 YEARS AND OLDER

  -  THOSE WHO HAVE OR ANTICIPATE HAVING CLOSE
CONTACT WITH AN INFANT AGED 
LESS THAN 12 MONTHS SHOULD RECEIVE A SINGLE DOSE OF TDAP.

  -
OTHER ADULTS AGES 65 YEARS AND OLDER MAY BE GIVEN A SINGLE DOSE OF
TDAP.

CHILDREN AGED 7
THROUGH 10 YEARS

  -  THOSE NOT FULLY VACCINATED AGAINST PERTUSSIS* AND FOR WHOM NO
CONTRAINDICATION 
TO PERTUSSIS VACCINE EXISTS SHOULD RECEIVE A SINGLE DOSE OF TDAP.

  -
THOSE NEVER VACCINATED AGAINST TETANUS, DIPHTHERIA, OR PERTUSSIS OR WHO 
HAVE UNKNOWN
VACCINATION STATUS SHOULD RECEIVE A SERIES OF THREE VACCINATIONS 
CONTAINING TETANUS AND
DIPHTHERIA TOXOIDS. THE FIRST OF THESE THREE DOSES SHOULD 
BE TDAP.

* FULLY VACCINATED IS
DEFINED AS 5 DOSES OF DTAP OR 4 DOSES OF DTAP IF THE 
FOURTH DOSE WAS ADMINISTERED ON OR AFTER
THE FOURTH BIRTHDAY.

 
02. PASS MSG TO MEDICAL LOG OFCRS, CMD CHANNELS, MED STAFF,
PHARMACY, SHOT
TEAMS, IMMUNIZATION CLINICS, SUPPLY OFCRS, AND SUPPORTED ACTYS/CTRS.

03.
AUTHORITY: DODD 5105.22 AND DODD 6025.13. ADDITIONALLY:

A. ARMY: SEE ARMY REGULATION (AR)
40-61, 28 JANUARY 2005, CHAPTER 4, AND THE 
DEPARTMENT OF THE ARMY SUPPLY BULLETIN (SB
8-75-11) FOR APPLICABLE POLICIES 
AND PROCEDURES.

B. AIR FORCE: AF ACTIVITIES WILL TAKE
ACTION AS PRESCRIBED IN AFI 41-209, MEDICAL 
LOGISTICS SUPPORT, CHAPTERS 3 AND 9. FOR MAJCOMS
& NGB--THIS MSG HAS BEEN 
TRANSMITTED TO ALL DESIGNATED SUBORDINATE MEDICAL ACTIVITIES.
04. SERVICE SPECIFIC POCS ARE AS FOLS (FAX NOS. ARE AVAILABLE 24 HRS);

ARMY: TELEPHONE COM:
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Last Modified Date: 05/23/2014