Dr. Pullen got his tetanus booster years early!

By Edward Pullen, MD
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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 for newborns, prior to receiving their 2, 4, and 6 month immunization series. Only 76% of children nationwide, and only 74% of children age 19-36 months in Washington state 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.
• As a health care provider, I feel a responsibility to first do no harm. 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 several cases confirmed in Pierce County, and a much bigger outbreak has occurred in California where a pertussis epidemic has been declared. It’s very likely that I’ll see patients with pertussis in the office, though 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 United States. 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 Tdap series at 2, 4, 6, 18 months and pre-kindergarten immunizations fades by the teen years. For the last five years we have had a new Tdap booster shot, which is recommended as 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-sixth grade immunization visit. Older teens and adults who have not had a Td booster in the last two years can get a Tdap booster. It is strongly recommended for new parents, anyone around children under 6 months old (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, but 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 in the United States for use in older adults, though it is used in Europe for older adults, and appears safe. Since the use of Tdap after age 65 is not recommended, it may not be covered by insurance.