PACE Case: Adacel Vs. Boostrix

A 72-year-old female with past medical history of gout, chronic kidney disease, congestive heart failure, and depression was ordered a set of immunizations at the PACE center. The order consisted of Zostavax, Pneumovax, and Adacel.

While either the Boostrix or the Adacel vaccinations may be administered because both provide immunity, the CareKinesis Pharmacist reviewed the patient’s Electronic Medical Record and recommended that the patient be given Boostrix, if available.

Adacel is indicated for patients aged 10 through 64 years. The Advisory Council on Immunization Practices (ACIP) recommends that adults 65 years of age and older be administered Boostrix, if feasible. However, ACIP has also concluded that either Tdap vaccine (Boostrix or Adacel) may be used. Adacel was not studied in the older (≥65 years) patient population, and therefore could not make the same claim as Boostrix. It is important to note that the two vaccines are not interchangeable. Adacel and Boostrix each contain a different number of pertussis antigens and different concentrations of the pertussis antigen and diphtheria toxoid.

Boostrix has a higher amount of the antigens and a higher concentration of the antigen and toxoid, giving the elderly the boost of immunity they require.

References:

  1. In: Lexi-Drugs Online. Hudson, OH: Lexi-Comp, Inc.; [Updated October 25, 2018; Accessed November 12, 2018].
  2. Centers for Disease Control and Prevention. Updated Recommendations for Use of Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis (Tdap) Vaccine in Adults Aged 65 Years and Older — Advisory Committee on Immunization Practices (ACIP). June 2012; https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6125a4.htm. Accessed November 13, 2018.

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