Dr. Pullen Got His Tetanus Booster Years Early!

This article originally appeared online at DrPullen.com, part of the HCPLive network.

Why? I’m not really at risk for tetanus; I stay away from working in the dirt when I can avoid it. I’m also not at much risk for diphtheria, the traditional second component of the Td (tetanus-diphtheria) booster shot. Still I decided to get the new Tdap booster well before my Td was due. Why? It was really a no-brainer:

• The new third component of the immunization is a booster shot to refresh immunity against pertussis, commonly known as whooping cough. Pertussis is a serious and life threatening disease to newborns prior to their achieving immunity by their 2-4-6 month immunization series. (Only 76% of children nationwide, and only 74% of children age 19-36 months in WA are current on immunizations according to CDC stats.) It also causes a prolonged and miserable coughing illness in otherwise well adults.
• The immunization has been shown to be safe and effective.
• If I contact a mild case of pertussis I could easily infect many patients and staff, including those at risk for severe complications of the disease. It’s the same reason I am first in line for my annual influenza vaccination.
• This summer there has been a significant outbreak of Pertussis on the west coast. There have been at several cases confirmed in Pierce County, WA, where I live, and much bigger outbreak in California, where a Pertussis epidemic has been declared. It’s very likely that I’ll see patients with Pertussis in the office, though I may not recognize them as Pertussis, as the diagnosis is often challenging and obscure.

Pertussis is a fairly common disease. There were 13,000 reported cases of Pertussis and 18 deaths in 2008 in the US. This disease is often under diagnosed so the actual incidence is likely much higher. It is most common in teens and children under 6 months. The immunity from the childhood Dtap series at 2-4-6-18 months and pre-kindergarten immunizations fades by the teen years. For the last 5 years we have had a new Tdap booster shot, recommended for a one time substitution for the older Td tetanus-diphtheria booster. It is now recommended that we give this to our kids at the pre-6th grade immunization visit. Older teens and adults who have not had a Td booster in 2 years or more can get a Tdap booster. It is strongly recommended for new parents, anyone around children under 6 months (who’s not occasionally around a baby?) and at the time the next tetanus booster is due.

There is some debate about immunizing pregnant women, and most experts recommend a Tdap booster immediately after giving birth. I am going to try to include Tdap in any preconception counseling visits I have, and to get women immunized prior to conception. Tdap is not approved for use in older adults, though it is used in Europe for older adults, and appears safe. In the US use of Tdap after age 65 is an off-label use, and may not be covered by insurance.

Ed Pullen, MD, is a board-certified family physician practicing in Puyallup, WA. He blogs at DrPullen.com — A Medical Bog for the Informed Patient.