The Centers for Disease Control and Prevention (CDC) listed immunization among the top 10 public health achievements of the 20th century.1 However, there is the threat of disease reemergence as populations go unvaccinated due in part to a lack of awareness, fear of side effects, busy schedules, and competing demands.2,3 As a pharmacist, you can confront these challenges by proactively identifying and educating patients who are eligible for vaccination.

Identifying Patients Eligible for Tdap
The CDC Advisory Committee on Immunization Practices (ACIP) recommends all patients 10 years of age and older be assessed to receive the Tdap vaccine, including if they:

  • Are Pregnant4-7
    Pregnant women should get a dose of Tdap during each pregnancy, preferably during the earlier part of gestational weeks 27 through 36, regardless of time since prior Td or Tdap vaccination.8,9
  • For new mothers who have never received Tdap before or whose vaccination status is unknown, Tdap is recommended in the immediate postpartum period before discharge from the hospital or birthing center.
  • Are Healthcare Personnel
    Receiving recommended vaccines is an essential prevention practice for healthcare personnel.10 However, in 2014, the CDC found that less than half (42.1%) of healthcare personnel had received Tdap vaccination in the prior 9 years.11
  • Will Be Around Infants
    It is important that everyone who will be in close contact with an infant is up-to-date with their pertussis vaccination (DTaP or Tdap, depending on age).12 New parents and grandparents may be interested and eligible for Tdap vaccination, if not already vaccinated.
  • Require Wound Prophylaxis
    Patients should take precautions against tetanus if there is no evidence of tetanus toxoid-containing vaccine in the previous 5 years. Tdap can be administered to patients 10 years of age and older who have not previously had Tdap.13 (If the patient has previously received Tdap, then Td is recommended instead.) People who might be more susceptible to puncture wounds may be interested and eligible for Tdap vaccination, if not already vaccinated.

Who Should Not Get Vaccinated?14

  • Individuals who have 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, should not get Tdap vaccine.
  • Anyone who has experienced a coma, decreased level of consciousness, or long, repeated seizures within 7 days after a previous dose of tetanus or diphtheria toxoid or acellular pertussis-containing vaccine, should not get Tdap, unless a cause other than the vaccine was found for these reactions.

What Are Some Additional Precautions?8
Prior to administration, consult with patients' physician if they:

  • have uncontrolled seizures, progressive encephalopathy, or another unstable neurological disorder
  • have a history of Guillain-Barre Syndrome
  • have a history of Arthus-type hypersensitivity reactions
  • have had severe pain or swelling after any vaccine containing diphtheria, tetanus or pertussis

Please refer to the prescribing information for product-specific contraindications, warnings and precautions, and adverse reactions. Please include the Vaccine Information Statement (VIS) in your discussion with patients about vaccination.

You Play a Vital Role in Disease Prevention
Many adults in the United States do not have a primary care provider and only half receive basic preventive care services.15 However, nearly all Americans (93%) live within 5 miles of a community retail pharmacy, offering an accessible solution.16 As a pharmacist, you can help patients without a primary care provider and counsel them on recommended vaccinations, including Tdap.

References:
1. Centers for Disease Control and Prevention. Ten great public health achievements—United States, 1900-1999. MMWR. 1999;48(RR12):241-243. 2. McLaughlin JM, McGinnis JJ, Tan L, Mercatante A, Fortuna J. Estimated human and economic burden of four major adult vaccine-preventable diseases in the United States, 2013. J Prim Prev. 2015;36(4):259-73. 3. Pertussis Outbreak Trends. Centers for Disease Control and Prevention website. https://www.cdc.gov/pertussis/outbreaks/trends.html. Updated September 8, 2015. Accessed April 18, 2017. 4. Centers for Disease Control and Prevention. Letter to Providers: Tdap and Influenza Vaccination of Pregnant Women. October 9, 2014. https://www.cdc.gov/flu/pdf/professionals/providers-letter-pregnant-2014.pdf. Accessed May 29, 2017. 5. Rationale: Why Vaccinate Pregnant Women? Centers for Disease Control and Prevention website. https://www.cdc.gov/pertussis/pregnant/hcp/rationale-vacc-pregnant-women.html. Updated January 27, 2015. Accessed May 29, 2017. 6. Centers for Disease Control and Prevention. Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) in pregnant women—Advisory Committee on Immunization Practices (ACIP), 2012. MMWR. 2013;62(7):131-135. 7. Centers for Disease Control and Prevention. Pertussis: Summary of Vaccine Recommendations. https://www.cdc.gov/vaccines/vpd/pertussis/recs-summary.html. Updated June 22, 2016. Accessed April 18, 2017. 8. Centers for Disease Control and Prevention. Recommended Immunization Schedule for Adults Aged 19 Years or Older, United States, 2017. https://www.cdc.gov/vaccines/schedules/downloads/adult/adult-combined-schedule.pdf. Accessed April 18, 2017. 9. Centers for Disease Control and Prevention. Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger, United States, 2017. https://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-child-combined-schedule.pdf. Accessed May 29, 2017. 10. Centers for Disease Control and Prevention. Immunization of health-care personnel: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. 2011;60(RR-7):1-45. 11. Williams WW, Lu PJ, O’Halloran A, et al. Surveillance of vaccination coverage among adult populations—United States, 2014. MMWR. 2016;65(SS-1):1-36. 12. Surround Babies with Protection. Centers for Disease Control and Prevention website. https://www.cdc.gov/pertussis/pregnant/mom/protection.html. Updated June 24, 2015. Accessed April 18, 2017. 13. Centers for Disease Control and Prevention. Preventing tetanus, diphtheria, and pertussis among adults: use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine. Recommendations of the Advisory Committee on Immunization Practices (ACIP) and recommendation of ACIP, supported by the Healthcare Infection Control Practices Advisory Committee (HICPAC), for use of Tdap among health-care personnel. MMWR. 2006;55(RR-17):1-37. 14. Tdap (Tetanus, Diphtheria, Pertussis) VIS. Centers for Disease Control and Prevention website. https://www.cdc.gov/vaccines/hcp/vis/vis-statements/tdap.html. Updated October 18, 2016. Accessed April 18, 2017. 15. Why Not the Best? Results from the National Scorecard on U.S. Health System Performance, 2011. The Commonwealth Fund website. http://www.commonwealthfund.org/publications/fund-reports/2011/oct/why-not-the-best-2011. Accessed April 19, 2017. 16. National Association of Chain Drug Stores. Chain pharmacy industry profile 2011-2012. Arlington, VA: NACDS; 2012.

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