TDaP Vaccine (Adacel®)

Section 1.1

Midwives may independently prescribe, order and administer this drug.

Adacel® vaccine – the tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine (TDaP) protects against Tetanus, Diphtheria and Pertussis. Adacel® promotes active immunity against diphtheria, tetanus, and pertussis as specific antibodies are produced. Pertussis (Whooping Cough) is a respiratory illness caused by the bacterium Bordetella pertussis. Diphtheria is a serious infection of the nose and throat that can result in severe breathing problems, heart failure and paralysis. Tetanus, also called “lockjaw” can be very serious if the breathing muscles are affected.

Rates of pertussis and its attendant complications are high in infants less than 6 months of age. These infants do not have the protection of a full series of pertussis immunizations (offered at 2, 4, 6 and 18 months). Pertussis can be very serious if it is contracted during early infancy, with mortality rates as high as 1% in infants less than 6 months of age and with 90% of pertussis deaths occurring in this age group. About 75% of infants with pertussis contracted it from a family member or caregiver. For these reasons a dose of pertussis containing vaccine is recommended during pregnancy. The vaccine provides passive protection to the infant by transfer of IgG transplacentally in the third trimester and by transfer of secretory IgA in breast milk. It also helps prevent transmission of pertussis to the infant after birth. In addition, to minimize the risk of transmission to the infant even further, all family members caring for the infant should be vaccinated against pertussis.

Indications and Clinical Use:

During a pertussis outbreak, the vaccine is recommended to individuals who have not received a pertussis containing vaccine within the last 5 years, or if history is unknown, and according to the following specific criteria:

  • Administered at any stage of pregnancy, preferably during the third or late second trimester (after 20 weeks’ gestation); or
  • If not administered during pregnancy, TDaP should be administered immediately postpartum to ensure immunity and to reduce risk of pertussis transmission to the newborn; and
  • A single dose of TDaP is recommended for anyone who has on-going close contact with those who are pregnant and children; and
  • To health care professionals for whom vaccine status is unknown or who have not previously received TDaP and who have direct patient contact; and
  • Adults ≥18 years of age who have not been immunized, including immigrants with unknown immunizations status.

Contraindications:

History of anaphylactic reaction to a previous dose of any tetanus, diphtheria, or pertussis-containing vaccine or to any component of the formulation. History of Guillain-Barré Syndrome (GBS) within 8 weeks of receipt of a tetanus containing-vaccine.

Warnings and Precautions:

Use with caution in patients with a history of bleeding disorders, thrombocytopenia and/or patients on anticoagulant therapy. Whenever vaccines are administered the midwife must send a record of immunization to the physician to whom care is transferred at 6 weeks postpartum. A record of immunization should also be sent to the local public health unit in communities where this is required.

Information on possible vaccine reactions must be given prior to administration.

Epinephrine (1:1,000) and Diphenhydramine hydrochloride should be available for immediate use in the event of an anaphylactic reaction.

Pregnancy:

Compatible

Lactation:

Category L1 – No Data – Compatible

Adverse Events:

Assessment of available data on the safety of TDaP vaccine in pregnancy was not suggestive of higher rates of adverse events. In addition tetanus and diphtheria toxoid vaccines have been used extensively during pregnancy to combat neonatal tetanus with no evidence of teratogencity.

All Adverse Events Following Immunization must be reported to the local Public Health Unit. Refer to the BCCDC for a detail overview of the definition/criteria for reporting. Adverse events following immunizations are generally mild; severe events resulting in permanent sequelae are extremely rare.

Minor local: redness, tenderness, swelling, pain.
Minor systemic: headache, decreased energy, generalized body-ache, nausea, diarrhea, fever, sore or swollen joints.
Severe: anaphylactic reaction.

Dosage and Administration:

IM: 0.5 mL – administered as a single injection of one dose.