When I first started training almost a quarter century ago, the immunization schedule was pretty easy to memorize. Of course, the Centers for Disease Control & Prevention (CDC) along with the Advisory Committee on Immunization Practices (ACIP) was constantly updating the schedule semi-annually as new vaccines were developed and new indications were approved by the Food & Drug Administration (FDA).
Back in the day, all infants got a series of 5 tetanus, diphtheria & pertussis (TdaP) vaccinations followed by tetanus & diphtheria (Td) every 10 years during adolescence & adulthood. We got used to asking our patients when they last had their tetanus booster whenever they came in for a laceration repair or puncture wound evaluation. But we ignored pertussis since whooping cough isn't really a big deal, right?
more than 6,200 patients were sickened by pertussis last year in California alone, including 10 infants who died. Sure, adults can tolerate a (whooping) cough for a prolonged period of time (with scattered outbreaks in nursing homes & hospitals since 2007). But it's our infants who can't. Nationwide, more than 21,000 cases were reported last year, including 26 deaths, of which 22 were in infants less than a year old.
Unfortunately, those at greatest risk of death from pertussis can only receive 3 vaccinations against the infection prior to their 1st birthday out of the 5 shot series with the 4th coming 6 months later and the 5th around 4-6 years of age. So what's the best way to protect our children?
Immunize the adults! Immunize the caregivers! Immunize anyone with close contact to newborn infants! TdaP had its indication expanded to include adults up to 64yo back in December 2008. But just last week, the FDA approved Boostrix brand of TdaP for administration to adults 65 years & older. Why? Grandparents often have close contact with their newborn grandchildren! So the next time one of your Medicare-age patients comes in showing off pictures of his/her new grandchild, consider updating his/her tetanus status with TdaP.