Vaccination Guidelines for Diphtheria, Tetanus, and Pertussis

Introduction to Vaccination Schedule

The Advisory Committee on Immunization Practices (ACIP) recommends a 5-dose series of DTaP vaccine for children, administered as follows: primary series at ages 2, 4, and 6 months, first booster at 15-18 months, and second booster at 4-6 years 1
Children who received their fourth DTaP dose before their 4th birthday should receive the fifth dose between ages 4-6 years, while those who received it at age 4 years or older do not need the fifth dose 1

The minimum age for the fifth dose is 4 years, with at least 6 months between the fourth and fifth doses 1
For children who started on an accelerated schedule, the fifth dose should still not be administered before the child is aged 4 years 1
No more than 6 doses of diphtheria and tetanus toxoid-containing vaccines should be administered before age 7 due to increased risk of adverse reactions 1

While using the same DTaP product for all doses is preferable, any licensed DTaP vaccine may be used to complete the vaccination series if the previously used product is unknown or unavailable 1
After completing the 5-dose DTaP series, adolescents should receive a single dose of Tdap at age 11-12 years, which can also serve as the catch-up dose if not fully immunized with DTaP 1
For those who received Tdap as part of catch-up at ages 7-10 years, another adolescent Tdap dose should be administered at age 11-12 years 1

For adults never vaccinated against tetanus, diphtheria, or pertussis, a 3-dose series with only one containing pertussis (Tdap) is recommended, with a preferred schedule of Tdap first, followed by Td ≥4 weeks later, then another Td 6-12 months later 1, 2
Tdap can substitute for any one of the Td doses in the 3-dose primary series 2
One dose of Tdap is recommended during each pregnancy, preferably between 27-36 weeks gestation, and for unvaccinated pregnant women, at least 2 properly spaced doses of tetanus toxoid-containing vaccine during pregnancy are recommended, with one being Tdap 1
A single dose of Tdap is recommended for all healthcare personnel who have not previously received it 1

If more than 5 years have passed since the last tetanus toxoid-containing vaccine, Tdap is indicated for persons ≥11 years who have not previously received Tdap 1
For adults with unknown vaccination history but likely previous vaccination, serologic testing can be considered, and if tetanus and diphtheria antitoxin levels are >0.1 IU/mL, previous vaccination is presumed, and only a single dose of Tdap is indicated 2
After Tdap, routine Td boosters are recommended according to the scheduled schedule 2

If Tdap is inadvertently administered instead of DTaP for one of the first 3 doses in young children, it should not be counted as valid, and a replacement dose of DTaP should be given 1
If DTaP is inadvertently administered to a fully vaccinated child aged 7-10 years, this dose should be counted as the adolescent Tdap dose 1