Advisory Panel: More Pertussis, Meningitis Booster Shots Needed
By Daniel J. DeNoon
WebMD Health News
Reviewed by Laura J. Martin, MD
Oct. 28, 2010 -- Prompted by a recent surge in whooping cough deaths, particularly in infants, the nation's chief vaccine advisory panel says more Americans of all ages should get Tdap booster shots.
In California, 10 infant deaths from whooping cough led to a massive vaccination campaign. Now the Advisory Committee on Immunization Practices (ACIP) has broadened its whooping cough vaccine recommendations.
Whooping cough, formally known as pertussis, is included in the five-dose Dtap (diphtheria-tetanus-acellular pertussis) vaccine series routinely given to children. Nearly all kids get this vaccine. But protection wanes over the years.
About half of teens and about 6% of adults have had the Tdap (tetanus-diphtheria-acellular pertussis) vaccine. One big reason is that ACIP recommendations were confusing: they left out kids ages 7 to 10, as well as adults over age 64.
Moreover, adults who got tetanus shots usually got a tetanus-diphtheria-only vaccine and not Tdap. If they then wanted Tdap, it was unclear how long they had to wait.
The ACIP's new recommendations fix these problems:
- Any teens or adults who haven't had a Tdap shot or who don't know their vaccine history should get a Tdap shot as soon as possible.
- Adults who have not had one should get a Tdap shot regardless of how recently they had a tetanus-diphtheria booster shot.
- All kids ages 11 to 18 who had their Dtap shots as children should get a single Tdap booster instead of one tetanus-diphtheria booster.
- All adults ages 65 and older who have never had a Tdap booster should get one if they think they'll ever have close contact with an infant.
- Kids ages 7 to 10 who have not completed the full Dtap series should get a Tdap shot.
Meningitis Booster at Age 16?
By a narrow 6-5 vote, with three abstentions, the ACIP voted to recommend a second meningococcal vaccination at age 16.
Meningococcal meningitis is rare, but when it strikes, it can kill a healthy young person in less than a day. Those who survive often are horribly crippled.
The illness most often strikes young people of college age. The vaccine is recommended at age 11 to 12.
Meningococcal vaccine protection was thought to last at least 10 years. But the ACIP was shaken by new data showing that vaccine protection likely disappears after only five years.
There hasn't yet been an increase in meningococcal cases or deaths, but the majority of the ACIP did not want to wait to see if this would happen.
Those who voted against the recommendation were swayed by the high cost of vaccinating all U.S. kids -- twice -- against a relatively rare, albeit severe, disease.
Moreover, the FDA pointed out to the ACIP that existing meningococcal vaccines are not licensed for use as booster shots -- and that if the booster is recommended, studies of the booster shot's safety and effectiveness are unlikely to be performed.
But spurred on by dramatic testimony by families and individuals affected by meningococcal meningitis, the majority of the panel voted to recommend the booster shot.
The ACIP recommendations must be formally enacted by the Department of Health and Human Services (HHS). It is extremely unusual for the HHS to override the ACIP, but the close vote and the objection by the FDA makes such an action more likely.
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SOURCES: Advisory Committee on Immunization Practices meeting, Oct. 27, 2010.
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