Tetanus Vaccination Guidelines

Vaccination Schedule

The Centers for Disease Control and Prevention (CDC) recommends a vaccination schedule consisting of a first dose of Tdap, a second dose of Td at least 4 weeks after the first dose, and a third dose of Td 6-12 months after the second dose for individuals who are not fully immunized 1
For individuals aged 7-18 years who are not fully immunized, the CDC recommends receiving one dose of Tdap, preferably as the first dose, in the catch-up series, with additional doses using Td if needed 1
For persons aged 11-12 years, Tdap is recommended regardless of the interval since the last tetanus-containing vaccine, as recommended by the CDC 1
If previously unimmunized, individuals should receive at least 2 properly spaced doses of tetanus toxoid-containing vaccine during pregnancy, with one being Tdap, as recommended by the CDC 1
The Advisory Committee on Immunization Practices (ACIP) recommends tetanus vaccines should be administered as a booster dose every 10 years throughout life for optimal protection against tetanus infection, with a complete series of three vaccinations for individuals who have never been vaccinated against tetanus 2

For persons ≥11 years requiring tetanus vaccination for wound management who have not previously received Tdap, Tdap is preferred over Td, as recommended by the CDC 1
For contaminated or tetanus-prone wounds, a Td or Tdap booster is recommended if >5 years since last dose, and for patients with unknown vaccination history, both vaccination and Tetanus Immune Globulin (TIG) are recommended, as recommended by the CDC 3
If it has been ≥5 years since the last tetanus toxoid-containing vaccine and the wound is tetanus-prone, Tdap should be administered (if not previously received), as recommended by the CDC 1
For patients with unknown/uncertain history or <3 doses, Td or Tdap vaccination and Tetanus Immune Globulin (TIG) 250 units IM are recommended, as recommended by the CDC 3

The vaccine series does not need to be restarted regardless of the time elapsed between doses, as recommended by the CDC 1
For adults who likely received tetanus vaccination but cannot produce documentation, serologic testing for antibodies to tetanus and diphtheria toxin can be considered to avoid unnecessary vaccination, as recommended by the CDC 1
The recommended schedule for Tdap administration is:
Dose Vaccine Interval
First dose Tdap -
Second dose Either Td or Tdap ≥4 weeks after first dose
Third dose Either Td or Tdap 6-12 months after second dose [2]
Routine booster doses are recommended every 10 years throughout life with either Td or Tdap, as recommended by the CDC and ACIP 4, 1

Healthcare workers should receive a single dose of Tdap regardless of when they received their last Td booster, with subsequent Td/Tdap boosters every 10 years, as recommended by the CDC and ACIP 1, 5
Close contacts of infants should receive a single dose of Tdap if they haven't previously received it, ideally at least 2 weeks before contact, as recommended by the CDC and ACIP 1
Pregnant women should receive one dose of Tdap during each pregnancy at 27-36 weeks gestation, preferably earlier in this window, regardless of prior Tdap vaccination history, as recommended by the CDC and ACIP 2, 1

Tdap is administered as a 0.5 mL intramuscular injection, with the preferred site being the deltoid muscle, according to the MMWR Recommendations and Reports 1
Tdap may be administered simultaneously with other vaccines at different anatomical sites, as per the MMWR Recommendations and Reports and CDC 1, 6, 7
The only absolute contraindication for concomitant administration is a severe allergic reaction (anaphylaxis) to a previous dose or vaccine component, as recommended by the ACIP 7, 1