Tetanus, Diphtheria, and Pertussis Vaccination Guidelines

Introduction to Vaccination Schedule

• The standard childhood series requires 5 total doses of DTP/DTaP before age 7 years, according to the Centers for Disease Control and Prevention 1, 2

Primary Series and Booster Doses

• If a child has received only one dose at 18 months, they need a complete primary series using Td vaccine, consisting of 3 doses, with the first dose given immediately, the second dose at least 4 weeks after the first, and the third dose 6-12 months after the second, as recommended by the American Academy of Pediatrics 3, 4
• At age 11-12 years, the child should receive a single Tdap dose to provide pertussis protection, following the guidelines of the American Academy of Pediatrics 3, 4
• If the child received prior doses before 18 months, they still need a fifth (booster) dose, which should have been given at ages 4-6 years, according to the Centers for Disease Control and Prevention 1, 2

Recommended Action at Age 7 and Beyond

• Administer Td vaccine at age 7, as the child is already 7 years old and DTaP is not licensed for this age, following the recommendations of the American Academy of Pediatrics 3, 4, 5
• At age 11-12 years, give a single Tdap dose for pertussis protection, as recommended by the American Academy of Pediatrics 3, 4
• Continue with Td boosters every 10 years thereafter, following the guidelines of the American Academy of Pediatrics 3, 4

Critical Pitfalls to Avoid

• Do not assume prior vaccination without documentation - treat uncertain histories as if no doses were given, as advised by the American Academy of Pediatrics 6
• Do not use DTaP at age 7 or older - it is not licensed for this age group and carries higher rates of adverse reactions, according to the Centers for Disease Control and Prevention 7
• Consider serologic testing if vaccination history is truly unknown - if antitetanus and antidiphtheria levels are each ≥0.1 IU/mL, previous vaccination is presumed and only a single Td dose would be needed, as recommended by the Centers for Disease Control and Prevention 6, 7

Tetanus, Diphtheria, and Pertussis Vaccination Catch-Up Schedule

Immediate Action and Catch-Up Schedule

• The Centers for Disease Control and Prevention recommends that a child with 3 prior DTPa doses receive a total of 5 doses of tetanus-diphtheria-containing vaccine before completing the series, with the remaining schedule consisting of 2 Td doses, the first given immediately and the second given at least 6 months after the first dose 8, 9, 10
• The American Academy of Pediatrics recommends that at age 11-12 years, a single Tdap dose should be administered to provide pertussis protection, which can be given as early as 5 years after the last Td dose 8

Critical Rationale and Pertussis Protection Strategy

• The Advisory Committee on Immunization Practices recommends that Td is the appropriate vaccine for all catch-up doses in children aged 7-10 years, as DTaP is not licensed for children ≥7 years and carries higher rates of adverse reactions in this age group 8
• The Centers for Disease Control and Prevention recommends that Tdap at age 11-12 years is essential to provide the first pertussis protection since the original 3 DTPa doses, with an interval of at least 5 years between the last Td dose and Tdap 8

Important Considerations

• The American Academy of Pediatrics recommends that catch-up vaccination should not be delayed, and should begin immediately to provide protection as soon as possible 11
• The Centers for Disease Control and Prevention recommends that the child needs 2 more doses to complete the series, as 3 doses alone do not constitute adequate protection 9, 10

Catch‑Up Vaccination with Td for Children Aged 7–10 Years

Licensing Restrictions

• The CDC indicates that the Tdap product Adacel is licensed for use only in individuals aged 10 to 64 years. 12
• The CDC indicates that the Tdap product Boostrix is licensed for use in individuals aged 10 years and older. 12

Inappropriateness of DTaP in Older Children

• The CDC states that DTaP is not indicated for persons ≥ 7 years because it contains higher amounts of diphtheria toxoid, which are associated with increased rates of adverse reactions in older children and adults. (Recommendation) 13, 12, 14

Management If DTaP Is Accidentally Administered

• The CDC advises that if DTaP is inadvertently given to an undervaccinated child aged 7–10 years, that dose should be counted as the Tdap dose of the catch‑up series, and the child should still receive the adolescent Tdap booster at age 11–12 years. (Recommendation) 15, 13

Timing of Pertussis Booster

• The CDC recommends that, in routine practice, the interval between the last Td dose and the subsequent Tdap dose should be at least 5 years; however, Tdap may be administered regardless of interval when clinically indicated. (Recommendation) 13