IAC Express 2010

• Tdap can be given regardless of the interval since the last Td was given. There is NO need to wait 2-5 years to administer Tdap following a dose of Td.
   
• Adolescents should receive a one-time dose of Tdap (instead of Td) at the 11- to 12-year-old visit.
   
• Adolescents and adults younger than age 65 years who have not received a dose of Tdap, or for whom vaccine status is unknown, should be immunized as soon as feasible. (As stated above, Tdap can be administered regardless of interval since the previous Td dose.)
   
• Adults age 65 years and older who have not previously received a dose of Tdap, and who have or anticipate having close contact with children younger than age 12 months (e.g., grandparents, other relatives, child care providers, and healthcare personnel), should receive a one-time dose to protect infants. (As stated above, Tdap can be administered regardless of interval since the previous Td dose.)
   
• Other adults 65 years and older who are not in contact with an infant, and who have not previously received a dose of Tdap, may receive a single dose of Tdap in place of a dose of Td.
   
• Children ages 7-10 years who are not fully immunized against pertussis (i.e., did not complete a series of pertussis-containing vaccine before their seventh birthday) should receive a one-time dose of Tdap.

Q: Aren't the October 2010 ACIP recommendations for expanded use of Tdap vaccine in children ages 7 through 9 years and in adults age 65 years and older different from what is on the package inserts?

A: Yes. Sometimes ACIP makes recommendations that differ from the FDA-approved package insert indications, and this is one of those instances. ACIP recommendations represent the standard of care for vaccination practice in the United States. In general, to determine recommendations for use, one should follow the recommendations of ACIP rather than the information in the package insert.


Q: I understand that ACIP recently voted to recommend administering a routine booster dose of quadrivalent meningococcal conjugate vaccine (MCV4) to all teens. Can you tell me more?

A: At its October 2010 meeting, ACIP voted to recommend that providers administer initial doses of MCV4 to all adolescents at age 11-12 years with a booster dose at age 16 years.


Q: Why did ACIP vote to recommend a routine booster dose of MCV4 for adolescents age 16 years and older?

A: In October 2005, ACIP recommended routine MCV4 vaccination for all adolescents at ages 11-12 years to protect them from meningococcal disease as older teens. The peak age for meningococcal disease is 16-21 years. In 2005, ACIP reasoned that higher MCV4 vaccination rates could be achieved if administering the dose were coupled with giving the Td booster dose at the 11- to 12-year-old visit. (The Td dose for 11- to-12-year-olds was replaced by Tdap in 2006.) Current data now indicate that the protection provided by MCV4 wanes within 5 years following vaccination. For this reason, in October 2010, ACIP voted to recommend an MCV4 vaccine booster dose to provide continuing protection during the peak years of vulnerability.


Q: We are trying to provide influenza vaccination to all eligible patients during their stay in our hospital. If a patient does not remember if he or she has already received the vaccine this season, should we go ahead and vaccinate?

A: If a patient or family member cannot remember if the patient received influenza vaccine this season and no record is available, proceed with administering influenza vaccine, even if it might mean an extra dose is given. When a patient reports that they HAVE received influenza vaccine but does not have written documentation, ACIP states that in the specific case of influenza vaccination, patient self-report of being vaccinated should be accepted as evidence of vaccination.