Focus on Tdap

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This resource is designed to support pharmacists’ consultations with patients about Tdap vaccinations. It provides information for pharmacists to consider when assessing, recommending, administering, and documenting Tdap vaccination.

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ASSESS NEED FOR Tdap VACCINE

WHO should receive the Tdap vaccine?  According to the CDC Advisory Committee on Immunization Practices (ACIP), all patients 10 years of age and older should be assessed and receive the Tdap vaccine if they:

  • Have not received a dose of Tdap.
  • Are pregnant.
    • Pregnant women should get a dose of Tdap during each pregnancy, preferably at 27 through 36 weeks gestation.
    • Tdap is recommended in the immediate postpartum period before discharge from the hospital or birthing center for new mothers who have never received Tdap before or whose vaccination status is unknown.
  • Require wound prophylaxis against tetanus if there is no evidence of tetanus toxoid-containing vaccine in the previous 5 years AND have not previously had Tdap.
    • Td is recommended if the patient has previously received Tdap.

It is important that all family members and caregivers of the infant are up-to-date with their pertussis vaccines (DTaP or Tdap, depending on age) before coming into close contact with the infant.

CONTRAINDICATIONS – Do not give Tdap if patient has:

  • Ever had a life-threatening allergic reaction after a previous dose of any diphtheria-, tetanus- or pertussis- containing vaccine, OR has a severe allergy to any part of this vaccine.
  • Been in a coma or experienced long repeated seizures within 7 days after a childhood dose of DTP or DTaP, or a previous dose of Tdap, unless a cause other than the vaccine was found.

PRECAUTIONS – Prior to administration, consult with patients’ physicians if they:

  • Have seizures or another nervous system problem.
  • Have severe pain or swelling after any vaccine containing diphtheria, tetanus or pertussis.
  • Ever had Guillain-Barré syndrome (GBS).
  • Are not feeling well on the day the shot is scheduled.

Please refer to prescribing information for product-specific contraindications, warnings and precautions.

WHEN should patients receive the Tdap vaccine?

ADOLESCENTS/ADULTS who have not received a dose of Tdap:

  • As soon as feasible, regardless of when patient may have received a tetanus toxoid-containing vaccine without pertussis.
  • At least 2 weeks prior to having contact with a newborn infant.
  • At the same time other vaccines are administered but at a different injection site.

PREGNANT PATIENTS:

  • During each pregnancy (ideally at 27-36 weeks gestation) regardless of the amount of time between pregnancies.
  • Immediately postpartum if not administered prior to birth of infant.

RECOMMEND Tdap VACCINE

WHY should patients receive the Tdap vaccine?

  • Pertussis can be a serious disease.  It is highly contagious and can last up to 7-10 weeks.
  • Many people, including family members, who spread pertussis may not know that they have the disease.
  • In one recent study of infants who contracted pertussis, approximately 85% got it from a member of their immediate or extended family when a source of the infection could be identified.
  • Complications in infants can include hospitalization, pneumonia, seizures, brain disorders, and in very rare cases, death.

PERTUSSIS CAN:

  • Make it difficult for patients to breathe.
  • Cause a severe cough.
  • Spread easily to others through coughing and sneezing.
  • Be especially serious and in very rare cases lead to death in young infants.

HOW SAFE is the Tdap vaccine?
Most people who receive the Tdap vaccine tolerate it well.  However, reactions may include:

MILD PROBLEMS that do not typically interfere with activities:

  • Pain where the shot was given
  • Redness or swelling where the shot was given
  • Mild fever (below 100.5°F)
  • Headache
  • Tiredness
  • Nausea, vomiting, diarrhea, stomach ache
  • Chills, sore joints
  • Body aches
  • Rash, swollen glands

MODERATE PROBLEMS that may interfere with activities but do not typically require medical attention:

  • Pain where the shot was given
  • Redness or swelling where the shot was given
  • Fever over 102°F
  • Headache
  • Nausea, vomiting, diarrhea, stomach ache
  • Swelling of the entire arm where the shot was given

SEVERE PROBLEMS that may result in inability to perform usual activities or require medical attention can include swelling, severe pain, bleeding and redness in the arm where the shot was given (rare).

ADMINISTER Tdap VACCINE

WHICH PERTUSSIS VACCINE PRODUCT should the patient receive?
There are 2 commercially available Tdap vaccines.  Consult vaccine prescribing information and ACIP recommendations when selecting the appropriate vaccine for your patient.

IT IS IMPORTANT TO REMEMBER:

  • Tdap vaccine is not the same as the DTaP vaccine used for childhood immunizations.
  • TT and Td vaccines do not contain pertussis vaccine and will not provide immunity against pertussis, although they can be used for the recommended 10-year booster for tetanus or for immediate wound management if the patient has already received Tdap.
  • Patients who receive products that do not contain pertussis (eg, Td) may receive the Tdap vaccine at any time if not previously immunized against pertussis.

Always give the patient the relevant Vaccine Information Statement (VIS) before administering the vaccine.

IF PATIENT IS HESITANT OR UNDECIDED
Patients who are hesitant may be asked to consider:

  • Severity of pertussis and increased risk to infants, older patients and others with health problems.
  • Peace of mind knowing they have taken action to help prevent pertussis within their family.
  • Convenience of being immunized in the pharmacy allows patients to be vaccinated when they are ready and may reduce the time and delay of making another appointment at the physician office.
  • Coverage by health plan or the potential to submit for direct reimbursement from insurance carrier or use health saving or flexible spending account funds.
  • The vaccination will be recorded in the pharmacy and, where applicable, reported to the physician and immunization registry.

DOCUMENT Tdap VACCINE

After administering the vaccine, create a permanent record.

  • Record the date the vaccine was administered; the vaccine’s manufacturer and lot number; and the name, address, and title of the person administering the vaccine.
  • Update the patient’s immunization record card.
  • Report the immunization to the state registry.
  • Send notification to the patient’s physician, if known.

Report any vaccine adverse events at https://vaers.hhs.gov.

ACKNOWLEDGMENTS

APhA gratefully acknowledges the financial support from GSK for development of this resource. The following individuals served as content and pharmacy immunization practice advisors:
Vincent A. Hartzell, PharmD
Monali (Mona) Majmudar, PharmD
Sarah McBane, PharmD
Litjen (L.J.) Tan, PhD, MS

ADDITIONAL RESOURCES

Information contained in this resource was adapted from multiple resources previously developed by the Immunization Action Coalition and based on ACIP recommendations. Users are encouraged to visit:  www.immunize.org and www.cdc.gov/vaccines/acip for additional details and updates.

REFERENCES

  1. Centers for Disease Control and Prevention. Pertussis (Whooping Cough). http://www.cdc.gov/pertussis/index.html. Accessed Jan 26, 2016.
  2. Centers for Disease Control and Prevention. Pertussis: Summary of Vaccine Recommendations. http://www.cdc.gov/vaccines/vpd-vac/pertussis/recs-summary.htm. Accessed Jun 3, 2015.
  3. Centers for Disease Control and Prevention. Diphtheria Vaccination: Who Needs It? http://www.cdc.gov/vaccines/vpd-vac/diphtheria/in-short-both.htm. Accessed May 22, 2014.
  4. Centers for Disease Control and Prevention. Pertussis: causes and transmission. http://www.cdc.gov/pertussis/about/causes-transmission.html. Accessed Sep 8, 2015.
  5. Centers for Disease Control and Prevention. Tdap (Tetanus, Diphtheria, Pertussis) VIS. www.cdc.gov/vaccines/hcp/vis/vis-statements/tdap.html. Accessed Sep 8, 2015.
  6. Centers for Disease Control and Prevention. Pertussis: signs and symptoms. www.cdc.gov/pertussis/about/signs-symptoms.html. Accessed Feb 24, 2015.
  7. Centers for Disease Control and Prevention. Pregnancy and Whooping Cough. http://www.cdc.gov/pertussis/pregnant/mom/get-vaccinated.html. Accessed May 29, 2015.
  8. Immunization Action Coalition. Standing Orders for Administering Tdap/Td Vaccine to Adults. http://www.immunize.org/catg.d/p3078.pdf. Accessed Oct 15, 2015.
  9. Centers for Disease Control and Prevention. Standards for Adult Immunization Practice. http://www.cdc.gov/vaccines/hcp/adults/for-practice/standards/index.html. Accessed Oct 28, 2015.
  10. Skoff TH, Kenyon C, Cocoros N, et al. Sources of infant pertussis infection in the United States. Pediatrics. 2015;136(4):635–641.
  11. Updated recommendations for the use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) in pregnant women – Advisory Committee on Immunization Practices (ACIP) 2012. Centers for Disease Control and Prevention website: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6207a4.htm. Updated February 22, 2013.

DISCLAIMER:
Although every reasonable effort is made to present current and accurate information for public use, APhA and its employees and agents do not make any warranty, guarantee, or representation as to the accuracy or sufficiency of the information contained herein, and APhA assumes no responsibility in connection therewith.  The information referenced in the document is provided “as is” with no warranties of any kind.  APhA disclaims all liability of any kind arising out of the use of, or misuse of, the information contained and referenced in this document.  The use of information in this document is strictly voluntary and at the user’s sole risk.

© 2016 by the American Pharmacists Association.  All rights reserved.

 

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