Decennial Booster Research Articles

Impfungen bei Erwachsenen

The vaccination programme for adults in Germany is based on the comprehensive immunization acquired during childhood and adolescence. The goal of these vaccinations given at regular intervals is to achieve effective immunization coverage lasting into old age. The public health authorities in Germany recommend, according to the Standing Vaccination Commission (STIKO) standards, that adults should receive at least a decennial booster vaccination against diphtheria and tetanus as well as a pertussis booster if the last pertussis vaccine was administered more than 10 years earlier. Individuals above the age of 60 additionally benefit from vaccinations against pneumococcal diseases and annual vaccinations against seasonal influenza. In special life situations, e.g. during pregnancy, vaccination against influenza is also recommended for younger people. The current amendments to the recommendations of the STIKO are aimed at definitive control of measles and eradication of rubella embryopathy. A periodic check-up of the individual vaccination status, and if appropriate completion of missing vaccinations is an important duty of every practising physician. Supporting the creation of herd immunity contributes to the protection of individuals as well as the whole population.

Vaccination necessary for Korean adults

The Korean Society of Infectious Diseases has provided vaccination schedules for adults residing in Korea since 2007. The primary goal of adult immunization is to maintain effective immunization coverage lasting into old age and to protect from opportunistic infections during the aging process. All adults should receive at least a decennial booster vaccination against diphtheria and tetanus as well as pertussis. Individuals above the age of 65 additionally benefit from vaccinations against pneumococcus. Even though everyone can get an annual influenza vaccine, the elderly population and persons who have chronic disease are considered the preferred group. Human papilloma virus vaccine is recommended for women under 26 years old as a catch-up vaccination. Universal hepatitis A vaccination might be helpful for persons in their 20s as a control measure nowadays under the hepatitis A epidemic. We carefully consider meningococcal vaccination for the military recruits and college student in dormitories. Furthermore, we should consider special vaccination for travelers or pregnant women. To assess vaccine benefits and risks, vaccination providers should understand the most effective strategies to reduce the burden of vaccine-preventable disease according to host status.

A decennial booster dose of reduced antigen content diphtheria, tetanus, acellular pertussis vaccine ( Boostrix™) is immunogenic and well tolerated in adults

Reduced-antigen-content diphtheria–tetanus–acellular-pertussis (dTpa) vaccines are predominantly recommended for once-in-a-lifetime use. A second dTpa ( Boostrix™, GlaxoSmithKline Biologicals) administration in 164 adults previously vaccinated with dTpa 10 years previously was evaluated. Before the decennial booster, 89.4% and 94.8% subjects were seroprotected (antibodies ≥0.1 IU/mL) for diphtheria and tetanus, respectively. One-month post-booster, all subjects were seroprotected/seropositive against all vaccine antigens. Robust GMC increases indicated a booster response similar to the first booster. The decennial booster was well tolerated without serious adverse events, consistent with product experience. This study supports replacing traditional Td boosters with dTpa, and use of Boostrix™ as a decennial booster. This study is registered at www.clinicaltrials.com NCT00548171.

Tetanus and Pertussis vaccines: their usefulness in the aging population

Immunization is a safe, effective and simple way of preventing life-threatening tetanus infection in children and adults, and is therefore recommended for all age groups in all European countries. In older persons, despite waning immunity with increasing age, the majority of vaccinees attain protective tetanus immunity under a proper vaccination schedule. Based on the scientific evidence, decennial boosters are recommended for elderly persons who have received primary tetanus vaccination in the past. Until recently, pertussis vaccination was understood as an early childhood intervention. Due to decreasing immunity, re-vaccination of youngsters and adults is recommended and is also considered for seniors 60 years and over. Routine immunization of seniors against pertussis every ten years yields a high level of protection of older individuals, and at the same time contributes to epidemiological control of pertussis in the population.

Cost-effectiveness of adult pertussis vaccination in Germany

Background The incidence of pertussis in adults is high despite good childhood vaccination coverage. An adult formulation of an acellular pertussis vaccine is licensed and available for use in Germany. Objective To evaluate the potential health benefits, risks, costs and cost-effectiveness of routine pertussis vaccination programs for German adults. Methods A Markov model was used to simulate health states and immunity levels associated with pertussis disease and vaccination. The following strategies were evaluated: (1) no adult pertussis vaccination, (2) one-time adult vaccination at 20–64 years, and (3) adult vaccination with decennial boosters. Our main outcome measures were costs (2006 Euros), cases prevented, incremental cost per case prevented and incremental cost per quality-adjusted life year (QALY) saved. We performed sensitivity analyses for key assumptions in the model including disease incidence, vaccine cost, vaccine efficacy, disease costs and frequency of adverse events. Future costs and benefits were discounted at 3%. Results At a disease incidence of 165 per 100,000, the one-time adult vaccination strategy would prevent 498,000 cases, and the decennial adult vaccination strategy would prevent 1 million cases. Approximately 31 million adults (∼62% of the cohort) would be vaccinated with a one-time adult vaccination strategy for a total program cost of 366 million Euros, while a decennial vaccination strategy would cost 687 million Euros. The one-time adult vaccination strategy resulted in CE ratios of 5800 Euros per QALY saved, or 160 Euros per pertussis case prevented. The decennial booster strategy cost 7200 Euros per QALY saved, or 200 Euros per case prevented. The results were most sensitive to assumptions about disease incidence and vaccine cost. Conclusions Routine vaccination of German adults aged 20–64 years with Tdap is cost-effective.

Cost Effectiveness of Pertussis Vaccination in Adults

Prior economic analyses have reached disparate conclusions about whether vaccinating adults against pertussis would be cost effective. Newly available data on pertussis incidence were used to evaluate the cost effectiveness of one-time adult vaccination and adult vaccination with decennial boosters. A Markov model was used to calculate the health benefits, risks, costs, and cost effectiveness of the following strategies: (1) no adult pertussis vaccination, (2) one-time adult vaccination at 20-64 years, and (3) adult vaccination with decennial boosters. The impact of the severity of pertussis illness, vaccine adverse events, and herd immunity on model outcomes were also examined. At a disease incidence of 360 per 100,000, the one-time adult vaccination strategy would prevent 2.8 million cases, and the decennial vaccination strategy would prevent 8.3 million cases. As disease incidence varied from 10 to 500 per 100,000, the one-time adult vaccination strategy was projected to prevent 79,000 to 3.8 million adult pertussis cases, while the decennial vaccination program would prevent 239,000 to 11.4 million cases. A one-time adult vaccination strategy would result in 106 million people vaccinated, or approximately 64% of the adult cohort, for a total program cost of $2.1 billion, while a decennial vaccination strategy would cost $6.7 billion. The one-time and decennial booster vaccination strategies result in cost-effectiveness ratios of <$50,000 per quality-adjusted life year saved if disease incidence in adults were greater than 120 cases per 100,000 population. Routine vaccination of adults aged 20 to 64 years with combined tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis is cost effective if pertussis incidence in this age group is greater than 120 per 100,000 population.

Recently occurring adult tetanus in Korea: emphasis on immunization and awareness of tetanus.

Since a nationwide childhood vaccination with tetanus toxoid, tetanus has become a rare disease in Korea. However, we recently experienced 17 cases of adult tetanus in a university hospital during a 21-month period. Seventy percent of the patients were female, and the mean age was 63 yr (range, 29-87). The majority (88.2%) of the patients did not get primary vaccinations for tetanus and decennial tetanus-diphtheria toxoid booster. Most patients (88.2%), who sustained acute injury, did not seek medical care for their wounds or did not receive the prophylaxis for tetanus. Tetanus was found most frequently among farmers. Tetanus was diagnosed initially only in 53% of patients. The case-fatality ratio was 23.5%. These cases show that recently occurring tetanus in Korea is a disease, affecting the elderly and the female who may have a lower immunity against tetanus, and the farmers who are likely to be exposed to Clostridium tetani. In addition, diagnosis of tetanus is often delayed in area where cases are seen infrequently. Therefore, improved education among patients and physicians, emphasis of anti-tetanus immunization and awareness of tetanus respectively, may be essential for the prevention of disease and the reduction of its mortality.

Issues Related to the Decennial Tetanus-Diphtheria Toxoid Booster Recommendations in Adults

In terms of disease prevention, reduction of adverse reactions, and cost benefit studies, a strong case can be made for a policy that focuses on assuring high levels of primary immunization with tetanus and diphtheria (Td) toxoids and abandons the decennial Td booster in favor of a single midlife booster at age 50-65 years. The addition of acellular pertussis antigens to Td for routine use in adults has potential problems in terms of schedule, cost, and possible adverse reactions. Careful risk/benefit studies are necessary to evaluate its effectiveness and priority.

Indications for acellular pertussis vaccines in adults: the case for selective, rather than universal, recommendations.

The availability of acellular pertussis vaccines, which appear to be both safe and immunogenic in adults, will require that vaccine advisory groups make recommendations regarding their use. Pertussis in adults has negligible mortality but is responsible for about one-quarter of cases of chronic cough syndrome in young adults. Parents and other infant caregivers are important transmitters of pertussis to infants, the group who have the highest morbidity and mortality. Assuming that further studies confirm the immunogenicity and safety profile of acellular pertussis vaccines in adults, recommendations can be made for its use for universal immunization of adolescents, epidemic control, and strongly considered targeted adults who give care to infants. Factors that mitigate against including acellular pertussis vaccine in the recommended decennial tetanus-diphtheria toxoids booster include the short duration of the immune response to the acellular pertussis vaccine, increased cost and reactogenicity, and the lack of vaccine delivery systems to most adults. The elderly and the infirm, who are the current focus of adult immunization programs, are unlikely candidates for pertussis immunization. Therefore, recommendations for use of acellular pertussis vaccine in adults should be selective, rather than universal.

Tetanus Immunization in Adults-Reply

In Reply. —A single tetanus booster for adults at the age of 65 years, as proposed by Drs Balestra and Littenberg,1may appear to be an appropriate tetanus prevention policy on the basis of cost-effectiveness analysis. For several reasons, however, we do not recommend changing the vaccination policy of decennial booster doses of tetanus and diphtheria toxoid (Td) at this time. First, neither person who developed tetanus in Kansas in 1993 had a history of receiving any tetanus vaccination.2Furthermore, serologic surveys have indicated that 31% to 71% of older adults (who may have never received the primary three-dose Td series) lack protective levels of antibody against tetanus.3Although compliance with the decennial Td vaccination policy recommended by the Advisory Committee on Immunization Practices (ACIP)4may be suboptimal, these doses may provide catch-up immunizations to people who never received the primary series. Second, many persons, such

Tetanus Immunization in Adults

<h3>To the Editor.</h3> —The report of the two cases of tetanus occurring in Kansas in 1993¹serves as an important reminder that this disease, rare in the United States, still occurs; that primary immunization is not universal; that appropriate wound management is necessary for secondary prevention; and that older Americans are particularly vulnerable. The epidemiology of tetanus in the United States has remained fairly stable over the last decade with about 50 to 60 cases yearly, with higher attack rates and higher mortality rates among older Americans, many of whom never received primary immunization.^2,3 Using formal decision analysis, we found that primary immunization in childhood and a single tetanus booster for elderly adults is a cost-effective alternative to the decennial booster policy for primary prevention of tetanus.⁴While the costs (charges) of care for two persons with tetanus may fund as many as 90 000 doses of