New Recommendations for Pertussis, Meningococcal Vaccinations

With the pertussis outbreak in California nearing a 60-year high in the number of cases reported, the CDC's Advisory Committee on Immunization Practices (ACIP) has voted to recommend the off-label use of tetanus, diphtheria, and acellular pertussis (Tdap) vaccine in two specific patient groups.

During a meeting held in Atlanta Oct. 27-28, the ACIP recommended that children ages 7-9 years who did not complete the recommended childhood series of diphtheria and tetanus toxoids and acellular pertussis (or DTaP) vaccine receive a catch-up dose of Tdap.

The ACIP also recommended that adults ages 65 and older who have close contact with infants receive a dose of Tdap—doses can be given to people in this age group who have not previously received the vaccination.

"Pertussis is not particularly dangerous to either of these two groups," said Doug Campos-Outcalt, MD, in a statement. "It can make them sick, but the purpose of this recommendation is to protect those in whom pertussis is dangerous—infants."

A booster dose of Tdap already is recommended for adolescents, starting as early as age 10 for the Boostrix (GlaxoSmithKline) or at age 11 with Adacel (Sanofi Pasteur).

As of Oct. 26, 10 infant deaths from pertussis had been reported in California this year. The California Department of Public Health reported that as of Oct. 19, the state had received reports of 6,257 confirmed, probable and suspected cases of pertussis. That number approaches the highest yearly total of cases in the state's recorded history, which was 6,613 cases in 1950.

California issued expanded pertussis immunization recommendations in August to include the following groups:

• Anyone age 7 years or older who is not fully immunized, including those who are older than 64;
• Women of childbearing age before, during or immediately after pregnancy; and
• Others who have contact with pregnant women or infants.

Several other states also have experienced increased pertussis activity this year, said Campos-Outcalt, who is associate head of the department of family and community medicine at the University of Arizona College of Medicine, Phoenix.

The ACIP also recommended changes for meningococcal vaccination. Children with persistent complement component deficiency, anatomic, or functional asplenia, HIV infection, or sickle cell disease are recommended to receive quadrivalent meningococcal conjugate vaccine (MCV4) as early as age two, with a booster dose to follow in either three or five years, depending on the age at which they received their first dose.

During last month's meeting, the ACIP voted to recommend a second MCV4 dose be added to the primary series for high-risk children. The recommendation for a booster dose either three or five years after that second dose remains in place.

In addition, all adolescents were already recommended to receive one dose of MCV4 at age 11 or 12 years (or at 13-18 years if not previously vaccinated); the committee now has voted to recommend a booster dose at age 16 for adolescents who received their first dose at the preteen (age 11 or 12) visit. Those who received their initial dose at ages 13-15 should get a booster dose five years after that first dose.

This latter change, according to Campos-Outcalt, reflects that fact that although the incidence of meningococcal disease is "low and getting lower," serological studies have shown that antibody levels conferred by the vaccine wane in time. People ages 16-21, particularly college freshmen living in dormitories, now are considered to be at increased risk for meningococcal disease.

Finally, the committee voted unanimously to adopt an evidence-based vaccination recommendation process. According to Jonathan Temte, MD, PhD, who served as chair of the committee's workgroup on evidence-based recommendations, an evidence-based framework for vaccination recommendation has been in development for years. The new process will be more transparent for stakeholders, including family physicians, he noted.

For more information:

• ACIP: Recommended Immunization Schedule for Persons Aged 0 Through 6 Years
• ACIP: Recommended Immunization Schedule for Persons Aged 7 Through 18 Years
• High Pertussis Activity in Several States Triggers Call for Vaccines

Do you support the implementation of an evidence-based vaccination recommendation process? How do you think this will benefit family physicians?