Over 50% of adults do not have protective tetanus or diphtheria antibodies, meaning most adults are not receiving routine Td boosters. Some insurances (including Medicare) will only pay for boosters to be given following trauma wounds. It is important to know the indications for Td in the setting of trauma but patients with insurance coverage should receive Td boosters every 10 years.
Pertussis incidence had been increasing since the 1970s. In 2012 there were over 42,000 cases reports in the US alone.5 Therefore, the ACIP now recommends replacing one dose of Td with Tdap in all adults. This is especially important in adults with close infant contact, healthcare workers, parents, and those in the childcare settings.
What to know in clinic:
Give Td booster every 10 years
Substitute Tdap for Td once (within primary series or as a booster)
If vaccine status unknown, given Tdap followed by Td every 10 years
Pregnant women get Tdap every pregnancy regardless of last Td/Tdap
No contraindications for immunocompromised host
Update primary series in unvaccinated adults: Give all 3 doses (0, 1 month, 6-12 months)
Contraindications: Encephalopathy not attributable to another cause within 7 days of previous pertussis dose.
Precautions: History of GBS within 6 weeks after previous tetanus dose, history of Arthus-type hypersensitivity rxns after previous tetanus/diphtheria dose, progressive or unstable neurological disorder or seizures should have pertussis vaccine delayed until treatment regimen established or condition stabilized