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The Korean Society of Infectious Diseases has been regularly developing guidelines for adult immunization since 2007. In 2023, the guidelines for the following seven vaccines were revised: influenza, herpes zoster, pneumococcal, tetanus-diphtheria-pertussis (Tdap), human papillomavirus (HPV), meningococcal, and rabies vaccines. For the influenza vaccine, a recommendation for enhanced vaccines for the elderly was added. For the herpes zoster vaccine, a recommendation for the recombinant zoster vaccine was added. For the pneumococcal vaccine, the current status of the 15-valent pneumococcal conjugate vaccine and 20-valent PCV was described. For the Tdap vaccine, the possibility of using Tdap instead of tetanus-diphtheria vaccine was described. For the HPV vaccine, the expansion of the eligible age for vaccination was described. For the meningococcal vaccine, a recommendation for the meningococcal B vaccine was added. For the rabies vaccine, the number of pre-exposure prophylaxis doses was changed. This manuscript documents the summary and rationale of the revisions for the seven vaccines. For the vaccines not mentioned in this manuscript, the recommendations in the 3rd edition of the Vaccinations for Adults textbook shall remain in effect. [ABSTRACT FROM AUTHOR]

Although adult immunization is different from children’s, vaccine preventable diseases (VPDs) for adults are significant in that they are more severe and cause more deaths than VPDs for children. Additionally, the emergence of new vaccines and an increase in the elderly population are increasing demands for policy support for adult vaccination. Accordingly, in this paper, I will look at the characteristics of adult immunization, policies that have been implemented in Korea, and considerations. [ABSTRACT FROM AUTHOR]

배경: The recombinant zoster vaccine (RZV) has demonstrated high vaccine efficacy (VE) against herpes zoster (HZ) in adults ≥50 years of age (YOA) in 2 phase 3 clinical trials (ZOE-50, NCT01165177; ZOE 70, NCT01165229). VE persisted up to year (Y)2 in the interim analysis of the extension study (ZOSTER-049, NCT02723773). Here, we describe the interim analysis for Y4 of the extension study. Understanding VE persistence and long-term protection against HZ can help optimize RZV use in adults ≥50 YOA. 방법: The study design is detailed in Fig. 1. Primary objective included VE against HZ during ZOSTER-049. Secondary objectives included VE against HZ from 1 month post-dose 2 in the ZOE-50/-70 studies until the end of Y4 of ZOSTER-049 (Y10 post-vacci- nation), persistence of vaccine-induced humoral immunogenicity in terms of anti-glycoprotein E (gE) antibody and cell-mediated immune response in terms of frequency of gE-specific CD4[2+] T-cells and safety. VE analysis for ZOSTER-049 used historical control estimates from the ZOE-50/-70 placebo groups. 결과: ZOSTER-049 enrolled 7,413 participants and 7,277 were included in VE analyses (Fig. 2). During 4 years of follow-up in ZOSTER-049, overall VE against HZ was 81.6% (95% confidence interval [CI]: 75.2-86.6). From 1 month post-dose 2 in ZOE-50/-70 until Y4 of ZOSTER-049, overall VE was 89.0% (95% CI: 85.6-91.3). In ZOSTER-049, anti-gE antibody concentrations persisted >5 times above pre-vaccination up to Y10 post-vaccination (Fig. 3A). Frequency of gE-specific CD4[2+] T-cells remained above pre-vaccination from Y6 to Y10 post-vaccination (Fig. 3B). No safety signals were identified until the end of ZOSTER-049 Y4. 결론: VE against HZ and immune responses to RZV remained high until the end of the observation period for this Y4 interim analysis, suggesting sustained clinical benefit of RZV in adults ≥50 YOA for at least 10 years after vaccination. RZV safety profile remained clinically acceptable. [ABSTRACT FROM AUTHOR]

Since the first coronavirus disease 2019 (COVID-19) vaccination on December 8, 2020 in the United Kingdome (UK), more than 250,000,000 people worldwide have been vaccinated against COVID-19 in more than 100 countries as of March 5, 2021 [1]. In Korea, COVID-19 vaccinations started from February 26, 2021 among health professionals who are directly involved in treating COVID-19 patients, employees, and residents in long-term care facilities, and first-line COVID-19 responders. According to the Korean public health plan for the introduction and vaccination of COVID-19 vaccines, it is expected that vaccination will be performed in people aged ≥65 years from the second quarter and in people aged <65 with underlying diseases from the third quarter. People with comorbidities are well known as high-risk groups for COVID-19 [2]. However, there have been many questions raised about the safety, efficacy, and recommendation for COVID-19 vaccination in individuals with underlying medical conditions. This article aimed to present the efficacy and safety of each COVID-19 vaccine based on the presence and types of comorbidities, and to summarize the guidelines recommended by the World Health Organization (WHO), as well those implemented in the United States of America (USA) and the UK. [ABSTRACT FROM AUTHOR]

Influenza is a very important respiratory infectious disease that causes seasonal epidemics and pandemics. A well-organized surveillance system is necessary to monitor and respond effectively to the epidemiologic features of influenza. Korea currently operates a national influenza surveillance system based on the clinical sentinel surveillance system, laboratory sentinel surveillance system, and hospitalization and mortality surveillance system. However, there is a need for a better national surveillance system due to a demand for various pieces of information related to influenza. This article discusses the general aspects of influenza surveillance systems and the future direction of the national influenza surveillance system ofKorea. [ABSTRACT FROM AUTHOR]

Background: From May to July 2015, the Republic of Korea experienced the largest outbreak of Middle East respiratory syndrome (MERS) outside the Arabian Peninsula. A total of 186 patients, including 36 deaths, had been diagnosed with MERS-coronavirus (MERS-CoV) infection as of September 30th, 2015. Materials and Methods: We obtained information of patients who were confirmed to have MERS-CoV infection. MERS-CoV in fection was diagnosed using real-time reverse-transcriptase polymerase chain reaction assay. Results: The median age of the patients was 55 years (range, 16 to 86). A total of 55.4% of the patients had one or more coexisting medical conditions. The most common symptom was fever (95.2%). At admission, leukopenia (42.6%), thrombocytopenia (46.6%), and elevation of aspartate aminotransferase (42.7%) were observed. Pneumonia was detected in 68.3% of patients at admission and developed in 80.8% during the disease course. Antiviral agents were used for 74.7% of patients. Mechanical ventilation, extracorporeal membrane oxygenation, and convalescent serum were employed for 24.5%, 7.1%, and 3.8% of patients, respectively. Older age, presence of coexisting medical conditions including diabetes or chronic lung disease, presence of dyspnea, hypotension, and leukocytosis at admission, and the use of mechanical ventilation were revealed to be independent predictors of death. Conclusion: The clinical features of MERS-CoV infection in the Republic of Korea were similar to those of previous outbreaks in the Middle East. However, the overall mortality rate (20.4%) was lower than that in previous reports. Enhanced surveillance and active management of patients during the outbreak may have resulted in improved outcomes. [ABSTRACT FROM AUTHOR]

The article presents the revisions to the adult immunization recommendations outlined in the "Adult Immunization" book published by the Korean Society of Infectious Diseases (KSID). Topics covered include recommendations on pneumococcal vaccine for adults, recommendations on tetanus-diphtheria-pertussis (Tdap) vaccine for pregnant women or women who plan on pregnancy and recommendations on herpes zoster vaccine.

Influenza, a highly communicable disease, causes variable epidemics annually and imposes public health problems and socioeconomic burden. In addition to vaccine, antiviral medication has an important role in treatment and prevention of influenza virus infection. As influenza virus is undergoing change of antigenicity and antiviral susceptibility, proper use of antiviral medication is important. This guideline encompasses treatment and chemoprophylaxis with antiviral medications for seasonal influenza based on the current influenza situation in Korea. These recommendations were intended for physicians in all medical specialties who provide care for influenza patients. [ABSTRACT FROM AUTHOR]

A correction to the article on the guideline for the revised adult immunization by health organization Korean Society of Infectious Diseases that was published in the 2014 issue is presented.

This survey investigated Korean physician attitudes toward the herpes zoster (HZ) vaccine. A total of 400 physicians answered a self-reported questionnaire. Most physicians knew that HZ poses a significant socioeconomic burden and had good know ledge about HZ and its vaccine. Physicians who did not recommend HZ vaccine were concerned about costs (90.7%, 78/86) and doubted the effectiveness of the vaccine (58.1%, 50/86). Patient demand had a profound effect on physicians decisions; 84.9% (73/86) of them who said not recommending HZ vaccine reported that they would provide the vaccine upon patient request. In conclusion, educational initiatives should be targeted toward both physicians and patients. [ABSTRACT FROM AUTHOR]

Chylothorax or chylous ascites is rare manifestation of tuberculosis. We report a case of simultaneous chylothorax and chylous ascites due to tuberculosis. A 17-year-old girl was admitted with fever, abdominal distention and dyspnea. Chest and abdominal computed tomography revealed bilateral pleural effusion, multifocal nodular consolidation on both lung fields and copious ascites and multiple necrotic lymphadenopathy in the abdominal cavity. Mycobacterium tuberculosis was isolated from sputum and pleural fluid. The patient was treated with anti-tuberculosis medication. Pleural effusion and ascites improved with the medication. [ABSTRACT FROM AUTHOR]

Neutralizing antibodies targeted at the receptor-binding domain of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein have been developed and now under evaluation in clinical trials. The US Food and Drug Administration currently issued emergency use authorizations for neutralizing monoclonal antibodies in non-hospitalized patients with mild to moderate coronavirus disease 2019 (COVID-19) who are at high risk for progressing to severe disease and/or hospitalization. In terms of this situation, there is an urgent need to investigate the clinical aspects and to develop strategies to deploy them effectively in clinical practice. Here we provide guidance for the use of anti-SARS-CoV-2 monoclonal antibodies for the treatment of COVID-19 based on the latest evidence. [ABSTRACT FROM AUTHOR]

Despite the global effort to mitigate the spread, coronavirus disease 2019 (COVID-19) has become a pandemic that took more than 2 million lives. There are numerous ongoing clinical studies aiming to find treatment options and many are being published daily. Some effective treatment options, albeit of variable efficacy, have been discovered. Therefore, it is necessary to develop an evidence-based methodology, to continuously check for new evidence, and to update recommendations accordingly. Here we provide guidelines on pharmaceutical treatment for COVID-19 based on the latest evidence. [ABSTRACT FROM AUTHOR]

배경 In sepsis, the systemic response systemic inflammatory response of the host to pathogens, host factors with poor prognosis include old age, frailty, and sarcopenia. Biomarkers to evaluate the diagnosis and severity of sepsis may be critical for adequate clinical decision and help improve the prognosis of sepsis. Among biomarkers, this study was conducted to evaluate the association between the myokine, cytokines produced and secreted by muscle cells, and the diagnosis and prognosis of sepsis, and also to evaluate whether myokine is associated with muscle mass. 방법 A prospective cohort study was conducted among adult sepsis patients who visited the emergency room of Korea University Ansan Hospital from January 2016 to January 2020. The myokines measured in this study were brain-derived neutrotrophic factor oncostatin M. Muscle mass index was measured by a board-certified radiologist on axial images of L3 vertebra level in patients underwent abdomen CT scan at the time of admission for sepsis. 결과 During the study population, 627 sepsis patients were included in the study. Of these, myokines were measured in 168 patients, and 66 patients (39.2%) were diagnosed as septic shock. The median SOFA score was 8 in sepsis group and 11 in septic shock group. The initial lactate levels were 2.5 and 5.6 mmol/L in sepsis and septic shock, respectively. In-hospital mortality rate was 39.3%, and the 7-, 14-, and 28-day mortality rates were 13.7%, 21.4%, and 26.8%, respectively. Among myokines, the median value of BDNF were 11.2ng/mL and 10ng/mL in sepsis and septic shock, respectively. The median value of oncostatin M were 102pg/mL and 111.6pg/mL in sepsis and septic shock, respectively. Total abdomi- nal muscle area index (TAMAI) were 34.6㎠/㎡ and 34.2㎠/㎡ in sepsis and septic shock, respectively. BDNF was statistically significantly different from sepsis (P < 0.001) and septic shock (P <0.001) com- pared with the control group, respectively. Oncostatin M in sepsis (P <0.001) and septic shock (P <0.001) were significantly different from the control group, respectively. Higher oncostatin M were asso- ciated with increased 14-day mortality (adjusted hazard ratio [aHR]: 1.01, 95% confidence interval [CI]: 1.00-1.02, P = 0.028) and 28-day mortality (aHR: 1.01, 95% CI 1.00-1.02, P = 0.010). BDNF at the di- agnosis of sepsis was statistically higher in survivors (12.15 ng/mL) than in deaths (8.19 ng/mL), where as oncostatin M showed no difference between the two groups. TAMAI showed higher value in the sur- vivors (35.23㎠/㎡) than in the deaths (30.6㎠/㎡). TAMAI did not show any association with myokines. 결론 In patients with sepsis and septic shock, BDNF was lower than that of healthy controls and oncostatin M was higher than that of healthy controls. Oncostatin M was associated with higher mortality in sepsis patients, and BDNF was significantly higher in sepsis survivors. Muscle mass did not show a significant association with myokine levels. [ABSTRACT FROM AUTHOR]

Since the first case was reported in Wuhan, Hubei Province, China on December 12, 2019, Coronavirus disease 2019 (COVID-19) has spread widely to other countries since January 2020. As of April 16, 2020, 10635 confirmed cases have been reported, with 230 deaths in Korea. COVID-19 patients may be asymptomatic or show various clinical manifestations, including acute symptoms such as fever, fatigue, sore throat; pneumonia presenting as acute respiratory distress syndrome; and multiple organ failure. As COVID-19 has such varied clinical manifestations and case fatality rates, no standard antiviral therapy regimen has been established other than supportive therapy. In the present guideline, we aim to introduce potentially helpful antiviral and other drug therapies based on in vivo and in vitro research and clinical experiences from many countries. [ABSTRACT FROM AUTHOR]

To develop a clinical practice guideline for vaccination in patients with autoimmune inflammatory rheumatic disease (AIIRD), the Korean College of Rheumatology and the Korean Society of Infectious Diseases developed a clinical practice guideline according to the clinical practice guideline development manual. Since vaccination is unlikely to cause AIIRD or worsen disease activities, required vaccinations are recommended. Once patients are diagnosed with AIIRD, treatment strategies should be established and, at the same time, monitor their vaccination history. It is recommended to administer vaccines when the disease enters the stabilized stage. Administering live attenuated vaccines in patients with AIIRD who are taking immunosuppressants should be avoided. Vaccination should be considered in patients with AIIRD, prior to initiating immunosuppressants. It is recommended to administer influenza, Streptococcus pneumoniae, hepatitis A, hepatitis B, herpes zoster, measlesmumps- rubella virus, human papillomavirus, and tetanus-diphtheria-pertussis vaccines in patients with AIIRD; such patients who planned to travel are generally recommended to be vaccinated at the recommended vaccine level of healthy adults. Those who live in a household with patients with AIIRD and their caregivers should also be vaccinated at levels that are generally recommended for healthy adults. [ABSTRACT FROM AUTHOR]

Background: Lamivudine and abacavir sulfate are widely used nucleoside/tide reverse transcriptase inhibitors (NRTI) backbone agents, which are recommended in major international treatment guidelines. The fixed-dose combination of lamivudine and abacavir sulfate has been developed to contribute to low pill burden of antiretroviral therapy (ART) regimen and patient adherence. A mandatory post-marketing surveillance was conducted in Korea to monitor the safety of Kivexa (lamivudine 300 mg/abacavir 600 mg). Materials and Methods An open label, multi-center, non-interventional post-marketing surveillance was conducted to monitor the safety of Kivexa from July 2011 to July 2017 in 23 hospitals in Korea. Subjects over 12 years old taking Kivexa per prescribing information were enrolled. The primary outcome was defined as the occurrence of any adverse events during the study period. Secondary outcomes included the occurrence of adverse drug reaction, the occurrence of serious adverse events and the effectiveness of Kivexa. Result A total of 600 patients from 23 hospitals were enrolled within the 6 years of study. The total observation period was 1,004 person-years. Three hundred and ten patients reported 674 adverse events. The incidence of upper respiratory infection (65 cases, 10.9%) was the highest, followed by diarrhea (20 cases, 3.3%), and nausea (18 cases, 3.0%). 109 subjects reported 71 events of adverse drug reactions, and the most common reaction was nausea in 2.33% of the subjects. Thirty-one subjects reported serious adverse events, none of them were considered drug related. From the total of 600 subjects, excluding 48 subjects who were 'effectiveness unassessable' by investigators, 552 patients were eligible for the subjective effectiveness analysis. 459 (83.2%) were evaluated as 'improved'. Proportion of subjects whose human immunodeficiency virus-RNA is <50 copies/ml was 61.2% (309/505) at the beginning of observation and increased to 91.9% (464/505) at the end of study period. Conclusions: The post-marketing surveillance showed the safety of Kivexa in HIV-1 patients in Korea. Ischemic cardiovascular events and hypersensitivity associated with Kivexa were few. There was no significant new safety information. This data may be helpful in implementing Kivexa and lamivudine/abacavir sulfate containing drugs in Korea. [ABSTRACT FROM AUTHOR]

Campylobacter infection causes gastrointestinal symptoms such as abdominal pain or diarrhea. Occasionally, Campylobacter bacteremia affects immunocompromised patients; however, serious outcomes are known to be rare. Here, we present a case of a patient with Campylobacter bacteremia who had underlying liver cirrhosis. The patient had fever and diarrhea. These symptoms subsided after treatment with cefotaxime. Campylobacter jejuni was isolated in the blood culture after 10 days. In addition, previously reported cases of Campylobacter bacteremia in Asian countries were reviewed with respect to antimicrobial sensitivities. [ABSTRACT FROM AUTHOR]

Background: The World Health Organization recommends the surveillance of influenza-like illness (ILI) and severe acute respiratory infection (SARI) to respond effectively to both seasonal influenza epidemics and pandemics. In Korea, the “Hospital-based Influenza Morbidity and Mortality (HIMM)” surveillance system has been operated to monitor ILI and SARI occurrences. Materials and Methods: A multi-center prospective observational study was conducted. Adult patients with acute respiratory infection (ARI) were enrolled during the 2011-12, 2012-2013, and 2013-2014 influenza seasons at the 10 university hospitals using the HIMM surveillance system. With respect to SARI and pneumonia development, risk profiles were analyzed in patients with ARI in Korea. Results: A total of 5,459 cases were eligible for this analysis. Among 5,459 cases with ARI, 2,887 cases (52.9%) were identified that they had influenza infection. Among enrolled cases, 750 cases belonged to the SARI group, while 4,709 cases belonged to the non-SARI group. With respect to pneumonia development, 317 cases were accompanied by pneumonia, and 5,142 cases were not. Multivariate analyses revealed that the following factors were associated with an increased risk of SARI: Old age (≥65 years) (odds ratio [OR] 2.69, 95% confidence interval [CI] 2.2-3.32), chronic heart disease (CHD) (OR 2.24, 95% CI 1.68-2.98), cerebrovascular disease (CVD) (OR 1.49, 95% CI 1.05-2.10), chronic obstructive pulmonary disease (COPD) (OR 2.34, 95% CI 1.48-3.69), asthma (OR 2.33, 95% CI 1.62-3.36), chronic kidney disease (CKD) (OR 2.62, 95% CI 1.73-3.99), chronic liver disease (OR 1.71, 95% CI 1.04-2.81), and autoimmune diseases (OR 2.53, 1.57-4.08). Multivariate analyses revealed that the following factors were independent risk factors for pneumonia development: Old age (≥65 years) (OR 5.71, 95% CI 4.10-7.94), CHD (OR 1.54, 95% CI 1.07-2.22), COPD (OR 2.34, 95% CI 1.48-3.69), asthma (OR 2.33, 95% CI 1.62-3.36), CKD (OR 2.62, 95% CI 1.73-3.99), immunocompromised conditions (OR 3.12, 95% CI 1.47-6.62), and autoimmune diseases (OR 3.35, 95% CI 1.79-6.27). The risk of SARI and pneumonia was increased by the number of concurrent chronic medical conditions. Conclusion: The risk of SARI and pneumonia development among adult patient with ARI was significantly increased by the presence or number of concurrent chronic medical conditions in Korea. [ABSTRACT FROM AUTHOR]

Background: For more effective and safer usage of antibiotics, the dosing strategy should be individualized based on the patients' characteristics, including race. The aim of this study was to investigate the population pharmacokinetic (PK) profiles of piperacillin and tazobactam in Korean patients with acute infections. Materials and Methods: At least four consecutive 2/0.25 g or 4/0.5 g doses of piperacillin/tazobactam (TZP) were intravenously infused over 1 h every 8 h for patients with creatinine clearance (CLcr) ≤50 ml/min or CLcr >50 mL/min, respectively. Blood samples from 33 patients at a steady-state were taken pre-dose and at 0 min, 30 min, and 4-6 h after the fourth infusion. The population PK analysis was conducted using a non-linear mixed-effects method. A likelihood ratio test was used to select significant covariates, with significance levels of P <0.05 for selection and P <0.01 for elimination. Results: Both piperacillin PK and tazobactam PK were well described by a two-compartment model with first-order elimination. Creatinine clearance and body weight, as covariates on clearance (CL) and volume of central compartment (V1), were selected among the covariates possibly affecting PK parameters of both drugs. CL was defined as CL = 2.9 + 4.03 × CLcr /47 for piperacillin and CL = 1.76 + 4.81 × CLcr /47 for tazobactam. V1 was defined as V1 = 19.5 × weight/60 for piperacillin and V1 = 22.6 × weight/60 for tazobactam. Conclusion: The PK profiles of TZP at a steady-state in Korean patients with acute infections were well described by a two-compartment model with first-order elimination. Both piperacillin and tazobactam clearances were significantly influenced by creatinine clearance. [ABSTRACT FROM AUTHOR]

배경 Sepsis is still one of the infectious diseases represented by high mortality rates. Rapid and accurate diagnosis of sepsis is necessary for early administration of antibiotics to improve the prognosis of sepsis. This study was designed to improve the rapid diagnosis of sepsis among the large number of patients admitted to the emergency room. 방법 We developed “K-Speed: Korea University-Korea Institute of Science and Technology SePsis Early prEdiction and Diagnosis algorithm”, a high performance clinical decision algorithm for early diagnosis of sepsis by the application of deep learning technique. The study population comprised of patients with Korean Triage and Acuity Scale (KTAS) score of 3 or higher, who visited emergency room (ER) between January 2016 and January 2020, and were classified as sepsis, septic shock, and non-sepsis according to the final diagnosis. K-Speed analyzed a combination of clinical data including demographics, vital signs, and laboratory findings to generate a sepsis and septic shock risk score. 결과 During study period, a total of 1208 patients were enrolled in this study. From 4-fold cross validation, the Area Under the Receiver Operating Characteristic (AUROC) of K-Speed was 0.83 to distinguish between sepsis and non-sepsis patients among severely ill patients in ER and was higher than procalcitonin (0.73). The sensitivity, specificity, accuracy, precision, and F1 score were 0.77, 0.79, 0.78, 0.80, and 0.78, respectively. The AUROC of K-Speed was 0.78 for distinguishing between septic shock and others. The sensitivity, specificity, accuracy, precision, and F1 score were 0.97, 0.19, 0.81, 0.83, and 0.89, respectively. 결론 K-Speed, a high performance clinical decision algorithm via deep learning based on demographics, vital signs, and laboratory findings showed relatively high AUROC to predict the onset of sepsis. K-Speed may be useful for early diagnosis of sepsis and septic shock in ER. [ABSTRACT FROM AUTHOR]

Background: The number of cases of pertussis reported has increased gradually in the last decade. Pertussis vaccination is the most effective strategy for the prevention of infection. Despite the fact that young infants are at the highest risk for pertussis, the rate of tetanus-diphtheria-acellular pertussis (Tdap) vaccination is presumed to be very low among women of childbearing age in Korea. The purpose of this study was to investigate the perceptions of women of childbearing age regarding Tdap vaccination in Korea. Materials and Methods: Women of childbearing age, who visited the Department of Obstetrics and Gynecology at 3 University hospitals in the Seoul and Gyeonggi-do provinces of Korea, were surveyed. Individual questionnaires were administered from April to May 2012. Demographic data, Tdap vaccination history, general knowledge about pertussis, and information on factors associated with decision on vaccination were collected. Results: Of the 500 reproductive-age women enrolled, only 4 (0.8%) had received the Tdap. The most common reason for non-vaccination was the lack of awareness of pertussis and information about the Tdap. Totally, 171 (34.2%) responded that they would receive a Tdap vaccination in the future. By multivariate analysis, general confidence in the effectiveness of the vaccine (odds ratio [OR] = 1.88, 95% confidence interval [CI] 1.17 to 3.01) was indicated as an important factor for deciding whether to receive the Tdap vaccine (P < 0.01). Conclusions: The coverage of Tdap vaccination of women of childbearing age, including pregnant women, is very low because of the lack of awareness of pertussis and the Tdap. Education of women of childbearing age about pertussis is very important to increase Tdap vaccination rates among these women, particularly during the perinatal period. [ABSTRACT FROM AUTHOR]