Tdap-Polio Vaccination in a 46-Year-Old Adult
No, a 46-year-old does not need another dose of Adacel-Polio after the initial dose for routine immunization. 1
Single Dose Recommendation for Tdap
Tdap (including Adacel) is licensed for a single dose only in adults. 1 Prelicensure studies on safety or efficacy of subsequent doses were not conducted. 1
After receiving the initial Tdap dose, subsequent tetanus and diphtheria protection should be maintained with either Td or Tdap boosters every 10 years. 2, 1
As of 2019 ACIP guidelines, either Td or Tdap can be used for decennial booster doses, providing flexibility in clinical practice. 2, 1
Polio Component Considerations
Routine poliovirus vaccination of adults residing in the United States is not necessary. 2 Most adults have minimal risk for poliovirus exposure and are already immune from childhood vaccination. 2
For adults who previously completed a primary polio series, only a single lifetime booster dose with IPV is needed if at increased risk for poliovirus exposure. 2 Available data do not indicate the need for more than one lifetime booster. 2
Polio vaccination in adults is recommended only for specific high-risk groups: travelers to polio-endemic areas, laboratory workers handling poliovirus specimens, healthcare workers with close contact to patients potentially excreting wild polioviruses, and members of communities with wild poliovirus disease. 2
Next Vaccination Timeline
The next tetanus-containing vaccine would be due 10 years after the Tdap dose. 3
At that time, either Td or Tdap can be administered according to current ACIP recommendations. 2, 3
Important Clinical Caveats
Exception for wound management: If this patient sustains a tetanus-prone wound and it has been ≥5 years since their last tetanus-containing vaccine, they would receive either Td or Tdap for wound prophylaxis. 2
Exception for pregnancy: If this patient becomes pregnant, Tdap should be administered during each pregnancy (preferably between 27-36 weeks gestation) to protect the infant from pertussis, regardless of interval since last Tdap. 1
Exception for close infant contact: If this patient will have close contact with an infant <12 months old and it has been >2 years since their last Td, a single dose of Tdap may be given. 1
No need to repeat the polio series: Even if documentation is unclear, do not restart any vaccination series. 4 If there is uncertainty about prior polio vaccination and the patient is not in a high-risk category, no polio vaccination is needed. 2