Adacel is approved for use as a booster immunisation for diphtheria, tetanus and pertussis protection. It may be purchased by adults who are not eligible to receive a funded tetanus, diphtheria and pertussis immunisation, as an alternative to purchasing a non-funded Boostrix vaccine dose.

Adacel is recommended but not funded for:

• Health care staff who work with infants less than one year of age
• Staff working in long-term care facilities
• Early childhood education staff
• Students in training for occupations that work with children
• Household and other close contacts of infants less than one year of age
• Adults with an underlying medical condition in whom prevention of pertussis is important, e.g. those with chronic respiratory/lung disease

Adacel is licensed as a booster vaccine. When the vaccine is used for a primary vaccination course use will be outside of current licensure and individuals need to be advised of this. No safety concerns are expected with use in these circumstances.

Catch-up doses

Adults requiring a boost of their pertussis immunity e.g., prior to travel, can receive either Boostrix or Adacel. A single dose of vaccine is usually enough to boost existing immunity to pertussis whether the adult has had a primary course of three pertussis containing vaccine doses in the past, or not as adults are expected to have had exposure to the disease in the community. However, past exposure to pertussis cannot be guaranteed for every individual. To be confident that an adult does has the best protection a course of three Adacel or Boostrix vaccines is recommended.

Three doses of diphtheria and tetanus vaccines are required for protection as exposure to these two diseases will not occur and therefore there will be no immunity to booster with a single dose of vaccine. Contracting tetanus does not confer immunity.

Storage and preparation

Store as per cold chain between 2°C to 8°C.

The vaccine’s normal appearance is a uniform, cloudy, white suspension which may sediment during storage. Shake well to uniformly distribute the suspension before use.

Administration

Adacel can be administered concurrently with other vaccines, including all National Immunisation Schedule vaccines. Separate syringes and different injection sites should be used.

The vaccine should be administered intramuscularly. The preferred site is into the deltoid muscle.

Adacel should not be given to:

• Anyone with severe allergy (anaphylaxis) to a previous dose of this vaccine or other tetanus, diphtheria or pertussis containing vaccines, or a component of the vaccine
• Administration of Adacel should be postponed in individuals suffering from a fever over 38°C. The presence of a minor infection is not a reason to delay immunisation

The vaccine can be administered to a breastfeeding woman

Specialist advice should be sought for the following groups:

• Those with bleeding disorders, such as haemophilia. The vaccine should be administered in accordance with the haematologist’s instructions. It may, in this situation only, be given subcutaneously

Adacel is approved for use as a booster vaccine and effectively increases a person’s existing immunity to tetanus, diphtheria and pertussis.

Unvaccinated children from seven years of age and adults are expected to have some immunity to pertussis from exposure to the disease in the community. A single dose of Adacel is expected boost their existing protection to pertussis. However, a single dose of Adacel will not provide protection against tetanus and diphtheria in a previously unvaccinated person. After administration of Adacel to individuals aged 11–64 years who had previously completed a primary course of tetanus, diphtheria and pertussis vaccines 9 out of 10 individuals demonstrated protection against tetanus and diphtheria.

Individuals also demonstrated boosted immune responses to the pertussis components. However, studies have not yet established a correlation between serology results and protection against pertussis. It is expected that immunisation does reduce carriage of the Bordetella pertussis bacterium and the associated disease.

There is no published information on the effectiveness of Adacel when it is used for a primary immunisation course. However, based on the general principles of the human immune response to vaccination, a primary course of three Adacel vaccines is expected to result in protection from tetanus, diphtheria and pertussis.

After vaccination protection from pertussis lasts for 4–6 years (after the disease protection lasts 10–15 years).

• Ezeanolue E, Harriman K, Hunter P, Kroger A, Pellegrini C. Centers for Disease Control and Prevention. General Recommendations on Immunization Recommendations of the Advisory Committee on Immunization Practices (ACIP);[updated 2020 July 27; cited 2020 September 30]. Available from: https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/downloads/general-recs.pdf
• Ministry of Health. Immunisation handbook [Internet]. Wellington: Ministry of Health; 2020 [updated 2020 September 28; cited 2020 September 30]. Available from: https://www.health.govt.nz/publication/immunisation-handbook-2020
• U.S. Food and Drug Administration. Package insert: Adacel [Internet]. Silver Spring (MD): U.S. Food and Drug Administration; 2012 [updated 2019 January; cited 2020 September 30]. Available from: http://www.fda.gov/downloads/BiologicsBloodVaccines/Vaccines/ApprovedProducts/UCM142764.pdf