Pertussis Booster Vaccination in Adulthood
Yes, adults who received full childhood pertussis vaccinations require a pertussis booster in adulthood, as immunity wanes approximately 5-10 years after childhood vaccination, leaving adults susceptible to pertussis infection and transmission. 1
Recommendations for Adult Pertussis Vaccination
Adults aged 19-64 years should receive a single dose of Tdap (tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine) to replace a single dose of Td (tetanus and diphtheria) for booster immunization if they received their last dose of Td >10 years earlier and have not previously received Tdap 1
Intervals shorter than 10 years since the last Td may be used for booster protection against pertussis, particularly in settings with increased risk for pertussis or its complications 1
The Advisory Committee on Immunization Practices (ACIP) specifically recommends a single dose of Tdap for all adults who have not previously received it, regardless of the time since their last tetanus or diphtheria toxoid-containing vaccine 1
Special Considerations for High-Risk Groups
Adults with Infant Contact
Adults who have or anticipate having close contact with infants aged <12 months (parents, grandparents <65 years, childcare providers) should receive a single dose of Tdap if not previously vaccinated 1
An interval as short as 2 years from the last Td is suggested for these individuals; shorter intervals can be used when necessary 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 not previously vaccinated 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
Rationale for Adult Pertussis Vaccination
Immunity to pertussis wanes approximately 5-10 years after completion of childhood vaccination, leaving adolescents and adults susceptible to pertussis 1
Since the 1980s, the number of reported pertussis cases has steadily increased, especially among adolescents and adults 1
Adolescents and adults with waning immunity are a major reservoir for transmission of pertussis, particularly to vulnerable infants 1
Pertussis remains endemic in the United States despite longstanding routine childhood pertussis vaccination, and is the least well-controlled among reportable bacterial vaccine-preventable diseases for which universal childhood vaccination has been recommended 1
Vaccine Efficacy and Safety
Prelicensure studies demonstrated safety and efficacy (inferred through immunogenicity) against tetanus, diphtheria, and pertussis when Tdap was administered as a single booster dose to adults 1
The efficacy of an acellular pertussis vaccine with the same pertussis antigens as those in one licensed product was 92% (95% CI = 32%-99%) against confirmed pertussis in a randomized trial in the United States 1
Tdap vaccine induces antibodies to pertussis antigens exceeding those associated with efficacy in infants, in both adolescents and adults 2
Implementation Considerations
Every visit of an adult to a healthcare provider should be regarded as an opportunity to assess vaccination status and provide protection against tetanus, diphtheria, and pertussis 1
After receiving a single dose of Tdap, subsequent tetanus and diphtheria protection should follow the standard decennial Td booster schedule, beginning 10 years after receipt of Tdap 1
Despite recommendations, adult Tdap coverage remains low, with lack of provider recommendation being a major obstacle to immunization 3
Historical Context
Prior to 2005, routine vaccination against pertussis was not recommended for persons ≥7 years of age, though it was recognized that adolescents and adults with waning immunity were a major reservoir for transmission 1
In 2005, Tdap vaccines formulated for use in adults and adolescents were licensed in the United States, leading to the current recommendations for adult booster doses 1
Long-term studies suggest that wP-primed individuals (those who received whole-cell pertussis vaccines in infancy, common before the 1990s) may benefit from enhanced long-lasting immunity compared to those who received only acellular pertussis (aP) vaccines 4
The evidence clearly supports the need for pertussis booster vaccination in adulthood, even for those who completed their childhood vaccination series, due to waning immunity and the importance of preventing transmission to vulnerable populations, particularly infants.