What is the recommended use and administration of Adacel (Tdap vaccine)?

Adacel (Tdap) Vaccine: Recommended Use and Administration

Adacel (Tdap) is recommended as a single dose for adults aged 19-64 years to replace a single dose of Td for booster immunization against tetanus, diphtheria, and pertussis, with flexibility to administer at intervals shorter than 10 years to protect against pertussis. 1

General Characteristics and Administration

• Adacel is a tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine administered as a single 0.5mL intramuscular injection 2
• Adacel is licensed for use in persons aged 11-64 years 1
• The vaccine contains reduced quantities of tetanus toxoid, diphtheria toxoid, and five pertussis antigens (pertussis toxoid, filamentous hemagglutinin, pertactin, and fimbriae types 2 and 3) 3

Routine Recommendations for Adults

• Adults aged 19-64 years should receive a single dose of Tdap to replace a single dose of Td for active booster vaccination if they received their last dose of Td >10 years earlier 1
• After receiving Tdap, subsequent tetanus and diphtheria protection should be maintained with Td boosters every 10 years 2
• As of 2019, either Td or Tdap can be used for decennial Td booster doses, tetanus prophylaxis for wound management, and catch-up immunization schedules 1

Special Populations and Situations

Adults with Close Contact to Infants

• Adults who have or anticipate having close contact with an infant aged <12 months (e.g., parents, grandparents aged <65 years, childcare providers) should receive a single dose of Tdap 1
• For these individuals, an interval as short as 2 years from the last Td is suggested; shorter intervals may be used 1
• Ideally, these adults should receive Tdap at least 2 weeks before beginning close contact with the infant 1

Healthcare Personnel

• Healthcare personnel who work in hospitals or ambulatory care settings with direct patient contact should receive a single dose of Tdap as soon as feasible if they haven't previously received it 1
• An interval as short as 2 years from the last dose of Td is recommended for healthcare workers; shorter intervals may be used 1

Wound Management

• For adults who require tetanus toxoid-containing vaccine as part of wound management, a single dose of Tdap is preferred to Td if they have not previously received Tdap 1
• As of 2019, either Td or Tdap can be used for tetanus prophylaxis in wound management in persons who have previously received Tdap 1

Pregnancy

• Pregnant women should receive Tdap during each pregnancy to prevent pertussis in infants too young for routine vaccination (off-label use) 1
• Women who have not previously received Tdap should receive a dose in the immediate postpartum period 1

Contraindications and Precautions

• Tdap is contraindicated in persons with a history of serious allergic reaction (anaphylaxis) to any component of the vaccines 1
• Tdap is contraindicated in persons with a history of encephalopathy within 7 days of administration of a pertussis vaccine not attributable to another identifiable cause 1
• Precautions include Guillain-Barré syndrome within 6 weeks of a previous tetanus toxoid vaccine, progressive neurologic disorder, uncontrolled epilepsy, or progressive encephalopathy 1

Safety Profile

• Pain at the injection site is the most common adverse event, reported in approximately 75% of recipients 2
• Severe pain occurs in approximately 4.6% of recipients 2
• The incidence of solicited local and systemic reactions is generally similar between Tdap and Td vaccines 3

Important Considerations

• Tdap is licensed for a single use only; prelicensure studies on safety or efficacy of subsequent doses were not conducted 1
• After receipt of Tdap, subsequent doses of tetanus and diphtheria toxoid-containing vaccines should follow guidance for the use of Td 1
• Intervals shorter than 10 years since the last Td may be used to protect against pertussis, particularly in settings with increased risk for pertussis or its complications 1