Tdap Vaccination Guidelines for Adults

Primary Recommendations

• The Centers for Disease Control and Prevention recommends that all adults aged 19-64 years should receive a single dose of Tdap to replace one Td booster if they have not previously received Tdap, regardless of the interval since their last tetanus vaccination 1, 2, 3
• Adults should continue with Td boosters every 10 years after receiving Tdap 1, 2

Standard Adult Vaccination Schedule

• Adults aged 19-64 years who received their last Td dose more than 10 years ago should receive a single Tdap dose to replace the next scheduled Td booster 1, 2, 3
• The standard interval can be shortened to as little as 2 years from the last Td dose when protection against pertussis is needed, particularly in high-risk settings 1, 2, 3

High-Priority Populations Requiring Accelerated Tdap

• The Centers for Disease Control and Prevention recommends that all healthcare workers in hospitals or ambulatory care settings with direct patient contact should receive Tdap as soon as feasible if not previously vaccinated 1, 5, 6
• Adults who have or anticipate having close contact with infants aged <12 months should receive Tdap at intervals <10 years since the last Td 1, 2, 3
• Women who did not receive Tdap before pregnancy should receive it in the immediate postpartum period before hospital discharge, or as soon as feasible thereafter 1, 2, 6

Wound Management Protocol

• For adults requiring tetanus toxoid-containing vaccine as part of wound management who have not previously received Tdap, a single dose of Tdap is preferred over Td 1, 2, 3
• For clean, minor wounds, no tetanus vaccination is needed if the last dose was within 10 years; if >10 years, give Tdap (if never received) or Td 4
• For contaminated or severe wounds, tetanus vaccination is needed if >5 years since last dose; give Tdap (if never received) or Td 7, 9, 4

Contraindications and Precautions

• History of serious allergic reaction (anaphylaxis) to any component of the vaccine is an absolute contraindication for Tdap vaccination 5
• History of Arthus reaction following a previous tetanus or diphtheria toxoid-containing vaccine is a precaution for Tdap vaccination 7, 8, 9

Special Clinical Situations

• During community pertussis outbreaks or periods of increased activity, consider administering Tdap at intervals <10 years since the last Td or TT if Tdap was not previously received 7, 8, 9
• Adults with a history of pertussis should still receive Tdap according to routine recommendations 7, 8, 9

Administration Details

• The dose of Tdap is 0.5 mL, administered intramuscularly, preferably into the deltoid muscle 5, 6
• If multiple vaccines are indicated, administer them during the same visit using separate syringes at different anatomic sites 5, 6

Rationale for Adult Pertussis Vaccination

• Immunity to pertussis wanes approximately 5-10 years after completion of childhood vaccination, leaving adolescents and adults susceptible 10
• Vaccinating adult contacts reduces the risk of transmitting pertussis to infants 1, 2, 3
• Acellular pertussis vaccine efficacy was 92% (95% CI = 32%-99%) against confirmed pertussis in U.S. randomized trials 10