Kretsinger Katrina, Broder Karen R, Cortese Margaret M, Joyce M Patricia, Ortega-Sanchez Ismael, Lee Grace M, Tiwari Tejpratap, Cohn Amanda C, Slade Barbara A, Iskander John K, Mijalski Christina M, Brown Kristin H, Murphy Trudy V
Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA 30333, USA.
MMWR Recomm Rep. 2006 Dec 15;55(RR-17):1-37.
On June 10, 2005, a tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine (Tdap) formulated for use in adults and adolescents was licensed in the United States for persons aged 11-64 years (ADACEL, manufactured by sanofi pasteur, Toronto, Ontario, Canada). Prelicensure studies demonstrated safety and efficacy, inferred through immunogenicity, against tetanus, diphtheria, and pertussis when Tdap was administered as a single booster dose to adults. To reduce pertussis morbidity among adults and maintain the standard of care for tetanus and diphtheria prevention and to reduce the transmission of pertussis to infants and in health-care settings, the Advisory Committee on Immunization Practices (ACIP) recommends that: 1) adults aged 19-64 years should receive a single dose of Tdap to replace tetanus and diphtheria toxoids vaccine (Td) for booster immunization against tetanus, diphtheria, and pertussis if they received their last dose of Td >or=10 years earlier and they have not previously received Tdap; 2) intervals shorter than 10 years since the last Td may be used for booster protection against pertussis; 3) adults who have or who anticipate having close contact with an infant aged <12 months (e.g., parents, grandparents aged <65 years, child-care providers, and health-care personnel) should receive a single dose of Tdap to reduce the risk for transmitting pertussis. An interval as short as 2 years from the last Td is suggested; shorter intervals can be used. When possible, women should receive Tdap before becoming pregnant. Women who have not previously received Tdap should receive a dose of Tdap in the immediate postpartum period; 4) health-care personnel who work in hospitals or ambulatory care settings and have direct patient contact should receive a single dose of Tdap as soon as feasible if they have not previously received Tdap. An interval as short as 2 years from the last dose of Td is recommended; shorter intervals may be used. These recommendations for use of Tdap in health-care personnel are supported by the Healthcare Infection Control Practices Advisory Committee (HICPAC). This statement 1) reviews pertussis, tetanus and diphtheria vaccination policy in the United States; 2) describes the clinical features and epidemiology of pertussis among adults; 3) summarizes the immunogenicity, efficacy, and safety data of Tdap; and 4) presents recommendations for the use of Tdap among adults aged 19-64 years.
2005年6月10日，一种用于成人和青少年的破伤风类毒素、白喉类毒素减量及无细胞百日咳疫苗（Tdap）在美国获得许可，适用于11至64岁人群（商品名ADACEL，由加拿大安大略省多伦多市赛诺菲巴斯德公司生产）。上市前研究通过免疫原性证明了该疫苗在作为单剂加强针给成人接种时，针对破伤风、白喉和百日咳的安全性和有效性。为降低成人百日咳发病率，维持破伤风和白喉预防的医疗标准，并减少百日咳在婴儿及医疗环境中的传播，免疫实践咨询委员会（ACIP）建议：1）19至64岁的成人若上次接种破伤风和白喉类毒素疫苗（Td）已超过或等于10年且此前未接种过Tdap，应接种一剂Tdap以替代Td进行破伤风、白喉和百日咳的加强免疫；2）距上次接种Td不足10年的间隔时间也可用于百日咳的加强保护；3）有或预期会与12个月以下婴儿密切接触的成人（如父母、65岁以下祖父母、儿童护理人员及医护人员）应接种一剂Tdap以降低百日咳传播风险。建议距上次接种Td最短间隔2年；也可采用更短间隔。如有可能，女性应在怀孕前接种Tdap。此前未接种过Tdap的女性应在产后立即接种一剂Tdap；4）在医院或门诊护理机构工作且直接接触患者的医护人员，若此前未接种过Tdap，应尽快接种一剂Tdap。建议距上次接种Td最短间隔2年；也可采用更短间隔。医疗感染控制实践咨询委员会（HICPAC）支持这些关于医护人员使用Tdap的建议。本声明：1）回顾美国百日咳、破伤风和白喉疫苗接种政策；2）描述成人百日咳的临床特征和流行病学；3）总结Tdap的免疫原性、有效性和安全性数据；4）提出19至64岁成人使用Tdap的建议。
