1 MEDICAL POLICY SUBJECT: IMMUNIZATIONS PAGE: 1 OF: 10 If a product excludes coverage for a service, it is not covered, ...
MEDICAL POLICY SUBJECT: IMMUNIZATIONS
EFFECTIVE DATE: 09/16/04 REVISED DATE: 10/20/05, 09/21/06, 07/19/07, 08/21/08, 07/16/09, 07/15/10, 07/21/11, 07/19/12, POLICY NUMBER: 2.01.42 07/18/13, 07/17/14, 07/16/15, 07/21/16 CATEGORY: Vaccines/Biologics PAGE: 1 OF: 10 • If a product excludes coverage for a service, it is not covered, and medical policy criteria do not apply. • If a commercial product, including an Essential Plan product, covers a specific service, medical policy criteria apply to the benefit. • If a Medicare product covers a specific service, and there is no national or local Medicare coverage decision for the service, medical policy criteria apply to the benefit. POLICY STATEMENT: Childhood and adult immunizations are eligible for coverage when: I. administered according to the official recommendations of the Advisory Committee on Immunization Practices (ACIP) to the Centers for Disease Control and Prevention (CDC), and II. the services are covered by a member’s contract/benefit design. ACIP recommendations are effective on the date of the ACIP meeting at which the recommendations were made and are considered official when publicized by the CDC. POLICY GUIDELINES: I.
Refer to the member’s subscriber contract and/or the Customer (Member/Provider) Service Department for specific contract age limitations for dependents.
II. Coverage criteria are adjusted when national guidelines are revised to address new vaccines or changes in vaccine indications or the CDC makes recommendations for changes in administration schedules related to national vaccine shortages. III. Coverage for vaccines related to or required only as a condition of work, travel or school are strictly contract dependent. DESCRIPTION: Immunization is the process of stimulating the body’s immune system to protect against a specific infection. Minute amounts of the specific bacteria or virus, in whole or part, are specially treated so that when given to the patient, they will stimulate the body’s immune system without actually causing disease. Some immunizations require “boosters,” or repeat doses of the same vaccine, to keep up the body’s protection against a specific bacteria or virus. Recommended Pediatric and Adult immunizations are addressed as part of the Health Plan’s Preventive Health Guidelines. The “Recommended Childhood Immunization Schedule – Birth to 18 years and “Catch-up” that is part of Preventive Health Services: Healthy Children to Age 19 guidelines is produced by the American Academy of Pediatrics (AAP), the ACIP of the CDC, and the American Academy of Family Physicians and can be referenced at: https://www.excellusbcbs.com/wps/portal/xl/prv/pc/cpg. The Childhood & Adolescent Immunization Schedules are also available at: http://www.cdc.gov/vaccines/. The following immunizations are included in the recommendations: • Diphtheria-Tetanus-Pertussis • Influenza (Seasonal) • Hepatitis A • Measles, Mumps, Rubella • Hepatitis B • Meningococcal • Haemophilus Influenza Type B (HiB) • Pneumococcal • Human Papillomavirus (HPV) (Cervarix [HPV2], Gardasil [HPV4, HPV9])
Proprietary Information of Excellus Health Plan, Inc. A nonprofit independent licensee of the BlueCross BlueShield Association
• Poliovirus • Rotavirus • Varicella
SUBJECT: IMMUNIZATIONS
EFFECTIVE DATE: 09/16/04 REVISED DATE: 10/20/05, 09/21/06, 07/19/07, 08/21/08, 07/16/09, 07/15/10, 07/21/11, 07/19/12, 07/18/13, 07/17/14, 07/16/15, 07/21/16 PAGE: 2 OF: 10
POLICY NUMBER: 2.01.42 CATEGORY: Vaccines/Biologics
The Preventive Care of Adults Ages 19 Years and Older guidelines include immunization schedules and information for both persons at “usual risk” and “at risk”. These guidelines are based primarily on recommendations from the Report of the US Preventive Services Task Force and the Department of Health and Human Services Centers for Disease Control and Prevention Recommended Adult Immunization Schedule and can be referenced at: https://www.excellusbcbs.com/wps/portal/xl/prv/pc/cpg. The Adult Immunization Recommendations Schedule is also available at: http://www.cdc.gov/vaccines/. The following immunizations are included in the recommendations: • Diphtheria-Tetanus-Pertussis • Human Papillomavirus (HPV) (Cervarix [HPV2], Gardasil [HPV4, HPV9]) • Hepatitis A • Influenza (Seasonal) • Pneumococcal • Hepatitis B • Measles, Mumps, Rubella • Varicella • Haemophilus Influenza Type B (HiB) • Meningococcal • Varicella Zoster (Shingles) According to New York State Law, every health insurance policy providing medical, major medical or similar comprehensive type coverage must provide coverage for necessary immunizations as recommended by the Advisory Committee on Immunization Practices (ACIP) to the CDC. CODES:
Number
Description
Eligibility for reimbursem*nt is based upon the benefits set forth in the member’s subscriber contract. CODES MAY NOT BE COVERED UNDER ALL CIRc*msTANCES. PLEASE READ THE POLICY AND GUIDELINES STATEMENTS CAREFULLY. Codes may not be all inclusive as the AMA and CMS code updates may occur more frequently than policy updates. Code Key: Experimental/Investigational = (E/I), Not medically necessary/ appropriate = (NMN). CPT:
90460
90461
Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first or only component of each vaccine or toxoid administered each additional vaccine or toxoid component administered
90620
Meningococcal recombinant protein and outer membrane vesicle vaccine, serogroup B (MenB), 2 dose schedule, for intramuscular use
90621
Meningococcal recombinant lipoprotein vaccine, serogroup B (MenB), 3 dose schedule, for intramuscular use
90630
Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, for intradermal use
90632
Hepatitis A vaccine (Hep A), adult dosage, for intramuscular use
90633
Hepatitis A vaccine (Hep A), pediatric/adolescent dosage-2 dose schedule, for intramuscular use
90634
Hepatitis A vaccine (Hep A), pediatric/adolescent dosage-3dose schedule, for intramuscular use
90636
Hepatitis A and hepatitis B vaccine (HepA-HepB), adult dosage, for intramuscular use
90644
Meningococcal conjugate vaccine, serogroups C & Y and Haemophilus influenzae type vaccine (Hib-MenCY), 4 dose schedule, when administered to children 2-18 months of age, for intramuscular use
90647
Hemophilus influenzae type b vaccine (Hib), PRP-OMP conjugate, 3 dose schedule, for intramuscular use Proprietary Information of Excellus Health Plan, Inc.
SUBJECT: IMMUNIZATIONS
POLICY NUMBER: 2.01.42 CATEGORY: Vaccines/Biologics
EFFECTIVE DATE: 09/16/04 REVISED DATE: 10/20/05, 09/21/06, 07/19/07, 08/21/08, 07/16/09, 07/15/10, 07/21/11, 07/19/12, 07/18/13, 07/17/14, 07/16/15, 07/21/16 PAGE: 3 OF: 10
90648
Hemophilus influenzae type b vaccine (Hib), PRP-T conjugate, 4 dose schedule, for intramuscular use
90649
Human Papillomavirus vaccine, types 6, 11, 16, 18, quadrivalent (4vHPV), 3 dose schedule, for intramuscular use
90650
Human Papillomavirus vaccine, types 16, 18, bivalent (2vHPV), 3 dose schedule, for intramuscular use
90651
Human Papillomavirus vaccine types 6, 11, 16, 18, 31, 33, 45, 52, 58, nonavalent (9vHPV), 3 dose schedule, for intramuscular use
90653
Influenza virus vaccine, inactivated (IIV), subunit, adjuvanted, for intramuscular use
90654
Influenza virus vaccine, split virus, preservative free, for intradermal use
90655
Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 mL dosage, for intramuscular use (revised 1/1/17)
90656
Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.5 mL dosage, for intramuscular use (revised 1/1/17)
90657
Influenza virus vaccine, trivalent (IIV3), split virus, 0.25 mL dosage, for intramuscular use (revised 1/1/17)
90658
Influenza virus vaccine, trivalent (IIV3), split virus, 0.5 mL dosage, for intramuscular use (revised 1/1/17)
90660
Influenza virus vaccine, trivalent, live (LAIV3), for intranasal use Note: Not covered for 2016-2017 influenza season as is not recommended for use by the CDC.
90661
Influenza virus vaccine trivalent (ccIIV3), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use (revised 1/1/17)
90662
Influenza virus vaccine (IIV), split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use
90664
Influenza virus vaccine, live (LAIV), pandemic formulation, for intranasal use
90666 (E/I)
Influenza virus vaccine (IIV), pandemic formulation, split virus, preservative free, for intramuscular use (pending FDA approval)
90667 (E/I)
Influenza virus vaccine (IIV), pandemic formulation, split virus, adjuvanted, for intramuscular use (pending FDA approval)
90668 (E/I)
Influenza virus vaccine (IIV), pandemic formulation, split virus, for intramuscular use (pending FDA approval)
90670
Pneumococcal conjugate vaccine, 13 valent (PCV13), for intramuscular use
90672
Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use Note: Not covered for 2016-2017 influenza season as is not recommended for use by the CDC.
90673
Influenza virus vaccine, trivalent (RIV3), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use
90674
Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use (effective 1/1/17) Proprietary Information of Excellus Health Plan, Inc.
SUBJECT: IMMUNIZATIONS
POLICY NUMBER: 2.01.42 CATEGORY: Vaccines/Biologics
EFFECTIVE DATE: 09/16/04 REVISED DATE: 10/20/05, 09/21/06, 07/19/07, 08/21/08, 07/16/09, 07/15/10, 07/21/11, 07/19/12, 07/18/13, 07/17/14, 07/16/15, 07/21/16 PAGE: 4 OF: 10
90680
Rotavirus vaccine, pentavalent (RV5), 3 dose schedule, live, for oral use
90681
Rotavirus vaccine, human, attenuated (RV1), 2 dose schedule, live, for oral use
90682 (E/I)
Influenza virus vaccine, quadrivalent (RIV4), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use (effective 1/1/17, pending FDA approval)
90685
Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.25 mL dosage, for intramuscular use (revised 1/1/17)
90686
Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.5 mL dosage, for intramuscular use (revised 1/1/17)
90687
Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use (revised 1/1/17)
90688
Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.5 mL dosage, for intramuscular use (revised 1/1/17)
90696
Diphtheria, tetanus toxoids, acellular pertussis vaccine and inactivated poliovirus vaccine (DTaP-IPV), when administered to children 4 years through 6 years of age, for intramuscular use
90697 (E/I)
Diphtheria, tetanus toxoids, acellular pertussis vaccine, inactivated poliovirus vaccine, Haemophilus influenzae type b PRP-OMP conjugate vaccine, and hepatitis B vaccine (DTaP-IPV-Hib-HepB), for intramuscular use (pending FDA approval)
90698
Diphtheria, tetanus toxoids, acellular pertussis vaccine, haemophilus influenzae type b, and inactivated poliovirus vaccine (DTaP-IPV/Hib), for intramuscular use
90700
Diphtheria, tetanus toxoids, and acellular pertussis vaccine (DTaP), when administered to individuals younger than 7 years, for intramuscular use
90702
Diphtheria and tetanus toxoids adsorbed (DT) when administered to individuals younger than 7 years, for intramuscular use
90707
Measles, mumps, and rubella vaccine (MMR), live, for subcutaneous use
90710
Measles, mumps, rubella, and varicella vaccine (MMRV), live, for subcutaneous use
90713
Poliovirus vaccine, inactivated (IPV), for subcutaneous or intramuscular use
90714
Tetanus and diphtheria toxoids adsorbed (Td), preservative free, when administered to individuals 7 years or older, for intramuscular use
90715
Tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap), when administered to individuals 7 years or older, for intramuscular use
90716
Varicella virus vaccine (VAR), live, for subcutaneous use
90723
Diphtheria, tetanus toxoids, acellular pertussis vaccine, hepatitis B, and inactivated poliovirus vaccine (DtaP-HepB-IPV), for intramuscular use
90732
Pneumococcal polysaccharide vaccine, 23-valent (PPSV23), adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use
90733
Meningococcal polysaccharide vaccine, serogroups A, C, Y, W-135, quadrivalent (MPSV4), for subcutaneous use Proprietary Information of Excellus Health Plan, Inc.
SUBJECT: IMMUNIZATIONS
POLICY NUMBER: 2.01.42 CATEGORY: Vaccines/Biologics
EFFECTIVE DATE: 09/16/04 REVISED DATE: 10/20/05, 09/21/06, 07/19/07, 08/21/08, 07/16/09, 07/15/10, 07/21/11, 07/19/12, 07/18/13, 07/17/14, 07/16/15, 07/21/16 PAGE: 5 OF: 10
90734
Meningococcal conjugate vaccine, serogroups A, C, Y and W-135 quadrivalent (MCV4 or MenACWY), for intramuscular use (revised 1/1/17)
90736
Zoster (shingles) vaccine (HZV), live, for subcutaneous injection
90738
Japanese encephalitis virus vaccine, inactivated, for intramuscular use
90739 (E/I)
Hepatitis B vaccine (HepB), adult dosage, 2 dose schedule, for intramuscular use (pending FDA approval)
90740
Hepatitis B vaccine (HepB), dialysis or immunosuppressed patient dosage, 3 dose schedule, for intramuscular use
90743
Hepatitis B vaccine (HepB), adolescent, 2 dose schedule, for intramuscular use
90744
Hepatitis B vaccine (HepB), pediatric/adolescent dosage, 3 dose schedule, for intramuscular use
90746
Hepatitis B vaccine (HepB), adult dosage, 3 dose schedule, for intramuscular use
90747
Hepatitis B vaccine (HepB), dialysis or immunosuppressed patient dosage, 4 dose schedule, for intramuscular use
90748
Hepatitis B and Haemophilus influenzae type b vaccine (Hib-HepB), for intramuscular use
90750 (E/I)
Zoster (shingles) vaccine (HZV), recombinant, sub-unit, adjuvanted, for intramuscular injection (effective 1/1/17, pending FDA approval) Copyright © 2016 American Medical Association, Chicago, IL
HCPCS:
G0008
Administration of influenza virus vaccine
G0009
Administration of pneumococcal vaccine
G0010
Administration of hepatitis B vaccine
Q2034
Influenza virus vaccine, split virus, for intramuscular use (Agriflu) Sipuleucel-t, minimum of 50 million autologous CD54+ cells activated with PAP-GM-CSF, including leukopheresis and all other preparatory procedures, per infusion
Q2035
Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (AFLURIA)
Q2036
Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (FLULAVAL)
Q2037
Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (FLUVIRIN)
Q2038
Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluzone)
Q2039
Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (not otherwise specified)
ICD9:
Numerous
ICD10:
Numerous
Proprietary Information of Excellus Health Plan, Inc.
SUBJECT: IMMUNIZATIONS
POLICY NUMBER: 2.01.42 CATEGORY: Vaccines/Biologics
EFFECTIVE DATE: 09/16/04 REVISED DATE: 10/20/05, 09/21/06, 07/19/07, 08/21/08, 07/16/09, 07/15/10, 07/21/11, 07/19/12, 07/18/13, 07/17/14, 07/16/15, 07/21/16 PAGE: 6 OF: 10
REFERENCES: American Academy of Pediatrics. 2016 Immunization schedules. Last updated 2016 Feb [http://redbook.solutions.aap.org/SS/Immunization_Schedules.aspx] accessed 6/14/16. American Academy of Pediatrics. Immunization. Last updated 2016 [http://www2.aap.org/immunization/index.html] accessed 6/14/16. American Academy of Pediatrics Committee on Infectious Diseases. Immunization for Streptococcus pneumoniae infections in high-risk children. Pediatrics 2014 Dec;134(6):1230-3. American Academy of Pediatrics. Recommendations for prevention and control of influenza in children, 2013-2014. Policy statement. Pediatrics 2013 Oct;132(4):1-16. American Academy of Pediatrics Committee on Infectious Diseases. Meningococcal conjugate vaccines policy update: booster dose recommendations. Pediatrics 2011 Dec;128(6):1213-8. American Academy of Pediatrics Committee on Infectious Diseases. Poliovirus. Pediatrics 2011 Oct;128(4):805-8. *American Academy of Pediatrics. Committee on Infectious Diseases. Prevention of rotavirus disease: updated guidelines for use of rotavirus vaccine. Pediatrics 2009 May;123(5):1412-20. American Academy of Pediatrics Committee on Infectious Diseases. Policy statement—Prevention of varicella: update of recommendations for use of quadrivalent and monovalent varicella vaccines in children. Pediatrics 2011 Sep;128(3):6302. American Academy of Pediatrics. Committee on Infectious Diseases. Recommendations for prevention and control of influenza in children, 2012-2013. Pediatrics 2012 Oct;130(4):780-92. American Academy of Pediatrics Committee on Infectious Diseases. Updated recommendations on the use of meningococcal vaccines. Pediatrics 2014 Aug;134(2):400-3. American College of Obstetricians and Gynecologists. Committee on Adolescent Health; Immunization Expert Work Group of the American College of Obstetricians and Gynecologists. Committee opinion no. 641: human papillomavirus vaccination. Obstet Gynecol 2015 Sep [http://www.acog.org/-/media/Committee-Opinions/Committee-on-AdolescentHealth-Care/co641.pdf?dmc=1&ts=20150706T0701411210] published online ahead of print 6/26/15. American College of Obstetricians and Gynecologists. Committee on Obstetric Practice and Immunization Expert Work Group; Centers for Disease Control and Prevention’s Advisory Committee on Immunization, United States; American College of Obstetricians and Gynecologists. Committee opinion no. 608: influenza vaccination during pregnancy. Obstet Gynecol 2014 Sep;124(3):648-51. American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 566: Update on immunization and pregnancy: tetanus, diphtheria, and pertussis vaccination. Obstet Gynecol 2013 Jun;121(6):1411-4. Baxter R, et al. Immunogenicity and safety of an investigational quadrivalent meningococcal ACWY tetanus toxoid conjugate vaccine in healthy adolescents and young adults 10 to 25 years of age. Pediatr Infect Dis J 2011 Mar;30(3):e418. *Centers for Disease Control and Prevention (CDC). Addition of severe combine immunodeficiency as a contraindication for administration of rotavirus vaccine. MMWR 2010 Jun 11;59(22):687-8. Centers for Disease Control and Prevention (CDC).Robinson CL; Advisory Committee on Immunization Practices (ACIP), ACIP Child/Adolescent Immunization Work Group. Advisory Committee on Immunization Practices recommended immunization schedules for persons aged 0 Through 18 years--United States, 2016. MMWR Morb Mortal Wkly Rep 2016 Feb 5;65(4):86-7. Centers for Disease Control and Prevention (CDC). Kim DK, et al; Advisory Committee on Immunization Practices. Advisory Committee on Immunization Practices recommended immunization schedule for adults aged 19 years or older: United States, 2016. MMWR Morb Mortal Wkly Rep 2016 Feb 2;65(4):88-90. Proprietary Information of Excellus Health Plan, Inc.
SUBJECT: IMMUNIZATIONS
POLICY NUMBER: 2.01.42 CATEGORY: Vaccines/Biologics
EFFECTIVE DATE: 09/16/04 REVISED DATE: 10/20/05, 09/21/06, 07/19/07, 08/21/08, 07/16/09, 07/15/10, 07/21/11, 07/19/12, 07/18/13, 07/17/14, 07/16/15, 07/21/16 PAGE: 7 OF: 10
Centers for Disease Control and Prevention (CDC). Advisory Committee on Immunization Practices (ACIP). Vaccines for Children Program. Vaccines to prevent meningococcal disease. Resolution 6/15-1. 2015 Jun 24 [http://www.cdc.gov/vaccines/programs/vfc/downloads/resolutions/2015-06-15-mening.pdf] accessed 6/16/16. *Centers for Disease Control and Prevention (CDC). FDA licensure of bivalent human Papillomavirus vaccine (HPV2, Cervarix) for use in females and updated HPV vaccination recommendations from the Advisory Committee on Immunization Practices (ACIP). MMWR 2010 May 28;59(20):626-9. *Centers for Disease Control and Prevention (CDC). Hepatitis A vaccination coverage among children aged 24 – 35 months --- United States, 2006 and 2007. MMWR 2009 Jul 3;58(25):689-94. Centers for Disease Control and Prevention (CDC). Markowitz LE, et al. Human papillomavirus vaccination: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2014 Aug 29;63(RR-05):1-30 [http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6305a1.htm?s_cid=rr6305a1_w]. Erratum in: MMWR Recomm Rep. 2014 Dec 12;63(49):1182 [http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6349a11.htm] accessed 6/3/15. *Centers for Disease Control and Prevention (CDC). Licensure of a diphtheria and tetanus toxoids and acellular pertussis adsorbed, inactivated poliovirus, and haemophilus B conjugate vaccine and guidance for use in infants and children. MMWR 2008 Oct 3;57(39):1079-80. *Centers for Disease Control and Prevention (CDC). Licensure of a diphtheria and tetanus toxoids and acellular pertussis adsorbed and inactivated poliovirus vaccine and guidance for use as a booster dose. MMWR 2008 Oct 3;57(39):1078-9. Centers for Disease Control and Prevention (CDC). Briere EC, et al; Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases. Prevention and control of haemophilus influenzae type b disease: recommendations of the advisory committee on immunization practices (ACIP). MMWR Recomm Rep 2014 Feb 28;63(RR-01):1-14. Centers for Disease Control and Prevention (CDC). Recommendation of the Advisory Committee on Immunization Practices (ACIP) for use of quadrivalent meningococcal conjugate vaccine (MenACWY-D) among children aged 9 through 23 months at increased risk for invasive meningococcal disease. MMWR Morb Mortal Wkly Rep 2011 Oct 14;60(40):1391-2. Centers for Disease Control and Prevention (CDC). Recommendations on the use of quadrivalent human papillomavirus vaccine in males--Advisory Committee on Immunization Practices (ACIP), 2011. MMWR Morb Mortal Wkly Rep 2011 Dec 23;60(50):1705-8. *Centers for Disease Control and Prevention (CDC); Advisory Committee on Immunization Practices. Updated recommendations for prevention of invasive pneumococcal disease among adults using the 23-valent pneumococcal polysaccharide vaccine (PPSV23). MMWR 2010 Sep 3;59(34):1102-6. *Centers for Disease Control and Prevention (CDC). Updated recommendations for use of haemophilus influenzae Type b (Hib) Vaccine: reinstatement of the booster dose at ages 12-15 months. MMWR 2009 Jun 26;58(24):673-4. *Centers for Disease Control and Prevention (CDC). Updated recommendations of the Advisory Committee on Immunization Practices (ACIP) regarding routine poliovirus vaccination. MMWR 2009 Aug 7;58(30):829-30. Centers for Disease Control and Prevention (CDC). Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine (Tdap) in pregnant women and persons who have or anticipate having close contact with an infant aged