Tetanus Vaccination Schedule and Recommendations

General Tetanus Vaccination Schedule

The Centers for Disease Control and Prevention recommends that a booster dose of tetanus-containing vaccine is given every 10 years to ensure continued protection against tetanus and diphtheria in the general population 1, 3
The Advisory Committee on Immunization Practices (ACIP) updated recommendations in 2019 allow for either Td (tetanus and diphtheria) or Tdap (tetanus, diphtheria, and acellular pertussis) to be used for decennial booster doses in individuals who have completed the primary childhood immunization series 1, 2
The first tetanus booster for adolescents should be Tdap at age 11-12 years, regardless of when the last tetanus-containing vaccine was given, as recommended by the ACIP 3, 4

Pregnant women should receive one dose of Tdap during each pregnancy, preferably between 27-36 weeks gestation, regardless of prior vaccination history, according to the ACIP recommendations 3, 5
For wound management, a tetanus-containing vaccine is indicated when more than 5 years have elapsed since the last dose, as recommended by the ACIP 5
For individuals who have never been vaccinated against tetanus, a 3-dose primary series is recommended: 1 dose of Tdap, followed by either Td or Tdap at least 4 weeks later, and a third dose of either Td or Tdap 6-12 months after the second dose, as recommended by the ACIP 5, 7

The ACIP has allowed either Td or Tdap to be used in situations where previously only Td was recommended since October 2019, providing flexibility in vaccine selection for decennial booster doses, tetanus prophylaxis for wound management, and catch-up immunization schedules 1, 8
For individuals who have never received Tdap, it is preferred over Td for the next tetanus booster, as recommended by the ACIP 9

Studies have shown that Tdap is safe and immunogenic even when administered at intervals shorter than 10 years after a previous tetanus-containing vaccine, according to the ACIP 3
Individuals with a history of Arthus reaction following a previous tetanus toxoid-containing vaccine should not receive a tetanus toxoid-containing vaccine until more than 10 years after the most recent dose, as recommended by the ACIP 9, 7

The ACIP recommends that adults who have never received Tdap should get one dose as soon as feasible, to avoid delaying Tdap vaccination 9
Only wounds in patients whose last tetanus vaccination was more than 5 years ago require tetanus prophylaxis, according to the ACIP 5
The 2019 ACIP update provides flexibility in vaccine selection, allowing either Td or Tdap to be used for booster doses, and healthcare providers should be aware of this update to avoid failing to recognize the flexibility in vaccine selection 1, 8