Division of Bacterial Diseases (DBD) News Bulletin
On February 23, 2011 the Advisory Committee on Immunization Practices (ACIP) approved revised recommendations for healthcare personnel (HCP) on use of Tdap vaccine and use of postexposure antimicrobial prophylaxis. Revised recommendations on use of Tdap in healthcare personnel incorporate the changes made by ACIP at the October 2010 meeting and support direct language to remove barriers to facilitate the uptake of Tdap.
Use of Tdap in healthcare personnel: The ACIP recommends that all HCP, regardless of age, should receive a single dose of Tdap as soon as feasible if they have not previously received Tdap and regardless of the time since last Td dose. Tdap is not currently licensed for multiple administrations. After receipt of Tdap, HCP should receive routine booster immunization against tetanus and diphtheria according to previously published guidelines. Hospitals and ambulatory-care facilities should provide Tdap for HCP and use approaches that maximize vaccination rates (e.g., education about the benefits of vaccination, convenient access, and the provision of Tdap at no charge).
Postexposure antimicrobial prophylaxis in healthcare personnel: Healthcare facilities should maximize efforts to prevent transmission of Bordetella pertussis. Respiratory precautions should be taken to prevent unprotected exposure to pertussis. Data on the need for postexposure antimicrobial prophylaxis in Tdap-vaccinated HCP are inconclusive. Some vaccinated HCP are still at risk for B. pertussis. Tdap may not preclude the need for postexposure antimicrobial prophylaxis. Postexposure antimicrobial prophylaxis is recommend for all HCP who have unprotected exposure to pertussis and are likely to expose a patient at risk for severe pertussis (e.g., hospitalized neonates and pregnant women). Other HCP should either receive postexposure antimicrobial prophylaxis or be monitored daily for 21 days after pertussis exposure and treated at the onset of signs and symptoms of pertussis.
On June 22, 2011 the ACIP voted to recommend that women’s healthcare providers should implement a maternal Tdap vaccination program for women who have not previously received Tdap. Healthcare providers should administer Tdap preferably during the third or late second trimester (after 20 weeks gestation). Alternatively, they can administer Tdap immediately postpartum. The ACIP also voted to recommend: (1) the cocooning strategy for adolescents and adults who have or anticipate having close contact with an infant aged less than 12 months; (2) that if a tetanus and diphtheria booster vaccination is indicated during pregnancy for a woman who has previously not received Tdap, then healthcare providers should administer Tdap preferably during the third or late second trimester; and (3) to ensure protection against maternal and neonatal tetanus, pregnant women who never have been vaccinated against tetanus should receive three vaccinations containing tetanus and reduced diphtheria toxoids during pregnancy. Tdap should replace one dose of Td, preferably during the third or late second trimester.
On June 22, 2011 the ACIP voted to recommend that certain groups of children aged 9 through 23 months at increased risk for meningococcal disease should receive a 2 dose series of MCV4-D, 3 months apart.
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