Evaluating Revaccination of Healthcare Personnel with Tdap: Factors to Consider
Since 2005, the Advisory Committee on Immunization Practices (ACIP) has recommended that healthcare personnel receive a single dose of Tdap; after receipt of Tdap, a dose of Td is recommended every 10 years. Currently, both Tdap products are Food and Drug Administration (FDA) approved for single use. In October 2014, ACIP considered Tdap revaccination of healthcare personnel. After review of available data, ACIP maintains the current recommendation for healthcare personnel to receive a single dose of Tdap and at this time does not recommend routine administration of additional doses.
If there is an increased risk of pertussis in a healthcare setting evidenced by documented or suspected healthcare-associated transmission of pertussis, revaccination of healthcare personnel with Tdap vaccine may be considered.
The following factors should be considered when evaluating whether to revaccinate healthcare personnel:
- Vaccinating healthcare personnel with Tdap is not a substitute for infection prevention and control measures, including post-exposure antimicrobial prophylaxis.
- Revaccinated healthcare personnel should still receive post-exposure antimicrobial prophylaxis when applicable.
- There is no supportive evidence that additional Tdap doses would prevent pertussis disease and transmission in a healthcare setting.
- Because infants are at greatest risk for severe or fatal pertussis, healthcare personnel who work with infants or pregnant women should be prioritized for revaccination, if implemented.
- Vaccine effectiveness studies suggest the duration of protection against pertussis afforded by Tdap vaccination in adolescents is less than 4 years but is not well defined in adults; therefore the optimal interval between Tdap doses is not known.
- As per ACIP recommendations, there is no minimum interval between Td and Tdap (CDC MMWR 2011).
- Data from clinical trials of a second dose of Tdap support intervals of 5 and 10 years (Knuf 2010, Halperin 2011, Mertsola 2010, Booy 2010, Halperin 2012).
- Despite high Tdap coverage and recent receipt of the vaccine, adolescents are experiencing high rates of pertussis in the United States.
Although an additional dose of Tdap may benefit individual healthcare personnel, the ability of Tdap vaccination to interrupt pertussis transmission or curtail a pertussis outbreak in a healthcare setting may be limited. Healthcare facilities considering repeat Tdap doses for healthcare personnel are encouraged to consult with their state and local public health departments regarding the use of additional doses of Tdap.