Vaccination Guidelines

Contraindications to Tdap Vaccination

• A history of severe allergic reaction (anaphylaxis) to any component of the vaccine is an absolute contraindication to Tdap vaccination, as recommended by the Advisory Committee on Immunization Practices (ACIP), the Centers for Disease Control and Prevention (CDC), and the American Academy of Pediatrics 1, 2
• A history of encephalopathy not attributable to another cause within 7 days of a previous dose of a pertussis-containing vaccine is an absolute contraindication to Tdap vaccination, as recommended by the ACIP and CDC 1
• Severe allergic reaction (anaphylaxis) to a previous dose of tetanus toxoid or any vaccine component is an absolute contraindication for tetanus toxoid-containing vaccines, as recommended by the CDC 3, 4, 1, 2

Safety of Tdap Vaccination in Patients with Shellfish Allergies

• Shellfish allergy is not a contraindication to Tdap vaccination, and patients with shellfish allergies can safely receive the Tdap vaccine, as recommended by the CDC 1
• Milk allergy is not a contraindication or precaution to receipt of DTaP or Tdap, and providers should continue to vaccinate persons with milk allergy as recommended, as stated by the CDC 4
• Other non-vaccine allergies, including nut allergies, are not contraindications to tetanus vaccination 4
• Receiving allergen extract immunotherapy is not a contraindication to tetanus vaccination 4

Vaccine Components and Allergies

• Some DTaP and Tdap vaccines might contain residual milk allergens from manufacturing ingredients, as reported by the CDC 4
• The CDC has conducted a review of VAERS data and concluded that no safety signal for anaphylaxis in patients with milk protein allergy was identified, as found by the CDC 4

Post-Vaccination Monitoring and Precautions

• Standard post-vaccination monitoring for 15-30 minutes is recommended for all patients, as with any vaccination, and the CDC recommends monitoring for anaphylaxis in patients with milk allergy 4
• A history of Guillain-Barré syndrome within 6 weeks after a previous tetanus toxoid-containing vaccine requires careful evaluation of risks and benefits before administering Tdap, as recommended by the CDC 5, 3
• A history of Arthus-type hypersensitivity reaction after a previous tetanus or diphtheria toxoid-containing vaccine requires consideration of deferring vaccination for at least 10 years since last dose, according to the CDC 5, 3
• Moderate or severe acute illness with or without fever requires deferring Tdap vaccination until resolution, according to the CDC 5, 3, 4, 1
• Unstable neurologic conditions, including progressive neurologic disorders, require careful evaluation and stabilization before vaccination 3, 1, 2
• Stable neurologic disorders, including well-controlled seizures, are not contraindications to Tdap vaccination, as stated by the CDC 5

Special Considerations

• Patients with contraindications to the pertussis component should receive Td vaccine instead of Tdap, as recommended by the American Academy of Pediatrics and the CDC 2, 5
• Patients with a history of anaphylaxis to components in all Tdap and Td vaccines should be referred to an allergist to determine if they have a specific allergy to tetanus toxoid and whether they can safely receive tetanus toxoid vaccination, according to the American Academy of Pediatrics and the CDC 2, 3
• The full recommended dose of vaccine should be used; divided or reduced doses are not recommended 6
• Assessment for true contraindications, such as previous anaphylaxis to tetanus toxoid or components, is necessary before proceeding with vaccination, and patients with such history should be referred to an allergist for evaluation and possible desensitization 3, 4, 1, 2