Tetanus, Diphtheria, and Pertussis Vaccination Guidelines

Primary Vaccination Decision Algorithm

• The Centers for Disease Control and Prevention recommends Tdap should be given once in a lifetime, with the exception of pregnancy, and Td should be used for all subsequent tetanus-diphtheria boosters every 10 years thereafter 1
• For adults ≥18 years who have never received Tdap, administer Tdap now, regardless of interval since last tetanus-containing vaccine, as recommended by the Advisory Committee on Immunization Practices (ACIP) 1, 2
• For adults ≥18 years who have previously received Tdap, use Td for routine 10-year boosters, according to the ACIP guidelines 1
• For adolescents and children (7-18 years), give one dose of Tdap as the adolescent booster at ages 11-12 years, as recommended by the ACIP 1
• For catch-up vaccination (ages 7-18), give Tdap as the first dose, then use Td for any additional needed doses, following the ACIP guidelines 1
• If Tdap is given at ages 7-10, still give another Tdap dose at ages 11-12 years, as per the ACIP recommendations 1

Wound Management

• For patients who have never received Tdap or have unknown Tdap history, use Tdap (preferred over Td) when tetanus vaccine is indicated, as recommended by the ACIP 1
• For patients who have documented prior Tdap, use Td when tetanus vaccine is indicated, according to the ACIP guidelines 1
• Tetanus-containing vaccine is indicated if >5 years since last dose for contaminated/tetanus-prone wounds, or >10 years for clean minor wounds, as recommended by the ACIP 1, 3
• For pregnant women requiring wound prophylaxis, use Tdap, as per the ACIP guidelines 1

Key Clinical Principles

• Tdap is licensed and recommended as a single-dose vaccine for the general population (except pregnancy), not for repeated administration, as stated by the ACIP 2, 4
• After receiving Tdap, all subsequent routine boosters should be Td every 10 years, according to the ACIP guidelines 1, 3
• When Tdap is indicated, administer it regardless of interval since the last tetanus or diphtheria-containing vaccine, as recommended by the ACIP 2, 5, 6, 7
• The ACIP concluded that protection against pertussis outweighs the potential risk of increased local reactions from shorter intervals 2, 5

Special Populations

• For adults ≥65 years, give Tdap if never received, preferably using Boostrix (though either product is acceptable), as recommended by the ACIP 2, 4, 5, 6, 7
• For unvaccinated adults, give 3-dose series with one dose being Tdap (preferred as first dose), followed by Td at ≥4 weeks, then Td at 6-12 months, according to the ACIP guidelines 1
• For pregnant women, administer Tdap during each pregnancy at 27-36 weeks (preferably early in this window), regardless of prior Tdap history, as recommended by the ACIP 1

Practical Summary Table