Tetanus and Diphtheria Vaccination Guidelines

Vaccine Composition and Administration

The Centers for Disease Control and Prevention recommends that each 0.5 mL dose of Td vaccine contains 2-10 Lf units of tetanus toxoid and ≤2 Lf units of diphtheria toxoid, which is a reduced dose compared to pediatric formulations, for individuals ≥7 years of age 1
The American Academy of Pediatrics suggests that Td formulations are adsorbed preparations administered intramuscularly, with a standard single-dose volume of 0.5 mL 1

The Centers for Disease Control and Prevention recommends a 3-dose primary series for individuals ≥7 years who have never been vaccinated, with the first dose of Td, second dose 4-8 weeks after the first, and third dose 6-12 months after the second 1
The Advisory Committee on Immunization Practices suggests that the preferred approach is to substitute Tdap for one dose in the series to provide pertussis protection, followed by Td for the remaining doses 2, 3

The Centers for Disease Control and Prevention recommends routine booster doses every 10 years throughout adult life to maintain protection against tetanus and diphtheria 1
The Advisory Committee on Immunization Practices suggests that for adolescents, the first booster should be Tdap at age 11-12 years, regardless of interval since last tetanus-containing vaccine 3
The American College of Physicians recommends that adults who have never received Tdap should receive one dose as soon as feasible, regardless of interval since last Td 2

The Centers for Disease Control and Prevention recommends that for contaminated or tetanus-prone wounds, administer a tetanus-containing vaccine if ≥5 years have elapsed since the last dose 2
The Advisory Committee on Immunization Practices suggests that Tdap is preferred over Td for persons ≥11 years who have not previously received Tdap 2

The American College of Obstetricians and Gynecologists recommends that pregnant women should receive one dose of Tdap during each pregnancy between 27-36 weeks gestation, regardless of prior vaccination history 4, 5
The Centers for Disease Control and Prevention suggests that healthcare personnel with direct patient contact should receive Tdap as soon as feasible, with intervals as short as 2 years after last Td acceptable 7

The Advisory Committee on Immunization Practices warns that administering tetanus boosters more frequently than every 10 years for routine immunization increases risk of Arthus-type hypersensitivity reactions 4, 6
The American Academy of Pediatrics advises that persons with history of Arthus reaction should not receive tetanus toxoid-containing vaccine until >10 years after the most recent dose, even for wound management 2, 5