Management of Tdap (Tetanus, Diphtheria, and Pertussis) Exposure
For individuals exposed to pertussis, postexposure prophylaxis with appropriate antibiotics should be administered, while those requiring tetanus prophylaxis after exposure should receive Tdap if they haven't previously received it, regardless of the interval since their last tetanus-containing vaccine. 1
Pertussis Exposure Management
Postexposure Prophylaxis
- Administer appropriate antibiotics to exposed individuals to prevent infection
- Continue postexposure prophylaxis even for healthcare personnel (HCP) who have previously received Tdap 1
- Implement prophylaxis particularly for:
- Close contacts of infants under 12 months
- Individuals in settings with increased risk of pertussis complications
- Healthcare personnel with direct patient contact
Healthcare Personnel Considerations
- Healthcare facilities should continue postexposure prophylaxis for vaccinated HCP who have unprotected exposure to pertussis 1
- Alternative approach: Some facilities may implement daily monitoring of exposed vaccinated HCP for early symptoms of pertussis for up to 21 days (incubation period) 1
- HCP should be removed from duty if early signs or symptoms of pertussis develop
Tetanus Exposure Management (Wound Management)
For Unvaccinated or Incompletely Vaccinated Individuals
- Begin or complete the primary 3-dose tetanus vaccination series
- For dirty or high-risk wounds: administer tetanus immune globulin (TIG) in addition to vaccine
- Use separate syringes and different anatomic sites for TIG and tetanus-containing vaccine 1
For Previously Vaccinated Individuals
- Tdap is preferred to Td for adults vaccinated >5 years earlier who require tetanus prophylaxis and have not previously received Tdap 1
- For those who have already received Tdap, use Td if a tetanus-containing vaccine is indicated 1
- No tetanus-containing vaccine needed if the person completed the 3-dose primary series and received a tetanus-containing vaccine <5 years earlier 1
Special Considerations
Arthus Reaction History
- Adults with history of Arthus reaction following a previous tetanus toxoid-containing vaccine should not receive another tetanus toxoid-containing vaccine until >10 years after the most recent dose 1, 2
- This applies even for wounds that are neither clean nor minor
Pertussis Outbreaks
- During periods of increased community pertussis activity or outbreaks, consider administering Tdap to adults at an interval <10 years since the last Td/TT if Tdap was not previously received 1
- The benefit of using a shorter interval is increased for adults with co-morbid medical conditions 1
History of Pertussis
- Adults with a history of pertussis should still receive Tdap according to routine recommendations 1
- Protection from natural pertussis infection may wane as early as 7 years after infection
- Diagnosis of pertussis can be difficult to confirm without culture for B. pertussis
Practical Implementation
- Verify vaccination history when possible
- Consider individuals with unknown or uncertain tetanus vaccination histories as having had no previous tetanus toxoid-containing vaccine 1
- The safety of an interval as short as 2 years between Td and Tdap is supported by research 1, 3
- No minimum interval is required between receipt of a tetanus toxoid-containing vaccine and Tdap when Tdap is otherwise indicated 2
Pitfalls to Avoid
- Don't withhold Tdap in appropriate situations due to concerns about the interval since the last tetanus-containing vaccine
- Don't assume that previous pertussis infection provides lifelong immunity
- Don't forget to consider Tdap for adults who have contact with infants under 12 months, as this helps protect the most vulnerable population
- Don't overlook the need for postexposure prophylaxis even in previously vaccinated individuals
By following these evidence-based guidelines, clinicians can effectively manage Tdap exposure situations while minimizing morbidity and mortality associated with tetanus, diphtheria, and pertussis.