有关破伤风类毒素、减毒白喉类毒素与无细胞百日咳(Tdap)疫苗在65岁及以上成人中使用的新推荐意见

Since 2005, the Advisory Committee on Immunization Practices (ACIP) has recommended a tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine booster dose for all adolescents aged 11 through 18 years (preferred at 11 through 12 years) and for those adults aged 19 through 64 years who have not yet received a dose (1,2). In October 2010, despite the lack of an approved Tdap vaccine for adults aged 65 years and older, ACIP recommended that unvaccinated adults aged 65 years and older be vaccinated with Tdap if in close contact with an infant, and that other adults aged 65 years and older may receive Tdap (3). In July 2011, the Food and Drug Administration (FDA) approved expanding the age indication for Boostrix (GlaxoSmithKline Biologicals, Rixensart, Belgium) to aged 65 years and older (4). In February 2012, ACIP recommended Tdap for all adults aged 65 years and older. This recommendation supersedes previous Tdap recommendations regarding adults aged 65 years and older.

The Pertussis Vaccines Work Group of ACIP reviewed the epidemiology of pertussis in adults aged 65 years and older and two cost-effectiveness models to assess the epidemiologic and economic impact of pertussis vaccination in this population. The Work Group also considered safety and immunogenicity data from clinical trials and observational studies on the use of Tdap in adults aged 65 years and older (3).

The two Tdap vaccines available in the United States, Boostrix and Adacel (Sanofi Pasteur, Toronto, Canada), differ in composition and approved age for use (Table). Only Boostrix is approved for adults aged 65 years and older; however, ACIP discussed the use of Adacel in this age group. On February 22, 2012, ACIP approved use of Tdap for all adults aged 65 years and older. This report summarizes data considered and conclusions made by ACIP and provides guidance for implementing the recommendation.

The Pertussis Vaccines Work Group of ACIP reviewed the epidemiology of pertussis in adults aged 65 years and older and two cost-effectiveness models to assess the epidemiologic and economic impact of pertussis vaccination in this population. The Work Group also considered safety and immunogenicity data from clinical trials and observational studies on the use of Tdap in adults aged 65 years and older (3). The Work Group then presented policy options for consideration to the full ACIP.

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