Given the ongoing and increasing presence of pertussis in the United States and the significant impact this has on the health of fragile populations, vaccinating adults against tetanus, diphtheria, and pertussis (Tdap) makes clinical, epidemiologic and Hippocratic sense.

However, with the current FDA indication for only one dose between ages 11 and 64 years, what strategies or processes have been employed to communicate to the patient whether he or she has received the one-time-only tetanus shot? Emergency departments have played a key role in delivering the tetanus vaccine to injured adults.

How do clinicians support their efforts at tetanus protection while visibly and candidly communicating the specific vaccine? My experience is that even health-care providers, having received the vaccine, are not articulate in the specifics of the indication. — Christine Keenan, MS, PA-C, Sherman, Conn.

Tdap in adults has been promoted to reduce the transmission of pertussis and is licensed for single-use-only. After receipt of a single dose of Tdap, adults should receive decennial booster with Td beginning 10 years after the receipt of Tdap.


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In 2011, the Advisory Committee on Immunization Practices is recommending single dose Tdap for adults older than age 65 years as well (off-label).

Prelicensure studies on the safety and efficacy of subsequent doses were not conducted, so it is unknown whether there will be adverse effects if Tdap is re-administered to adults. I agree that clinicians probably have not communicated this information well to patients. Immunization cards for adults and vaccine information handouts are available online and may be helpful. — JoAnn Deasy, PA-C, MPH (153-01)