Ask the Experts: Tetanus

Results (86)

Yes. Adolescents or adults who have a history of pertussis disease generally should receive Tdap according to the routine recommendation. This practice is recommended because the duration of protection induced by pertussis disease is unknown (waning might begin as early as 7 years after infection) and because diagnosis of pertussis can be difficult to confirm. Administering pertussis vaccine to people with a history of pertussis presents no theoretical risk. For details, visit CDC’s published recommendations on this topic at www.cdc.gov/mmwr/volumes/67/rr/pdfs/rr6702a1-H.pdf.

Last reviewed: March 31, 2022

Tdap vaccination status does not change the approach to evaluating postexposure prophylaxis when HCWs are exposed to pertussis. Tdap vaccines have an uncertain role in the prevention of transmission of pertussis and herd protection. Antipertussis antibody levels begin to decline precipitously after the first year following a single Tdap vaccination. Healthcare facilities should follow the post-exposure prophylaxis protocol for pertussis exposure recommended by CDC regardless of a HCW’s vaccination status (see www.cdc.gov/pertussis/pep.html). HCW can either receive postexposure prophylaxis or be carefully monitored for 21 days after pertussis exposure. Health care personnel should be treated with antibiotics at the onset of signs and symptoms of pertussis and excluded from work for the first 5 days while receiving appropriate antibiotics. CDC supports targeting postexposure antibiotic use to people at high risk of developing severe pertussis, as well as people who will have close contact with others at high risk of developing severe pertussis.

Last reviewed: October 31, 2023

Recent Tdap vaccination does not affect PCR testing. PCR tests are used to detect DNA sequences of the Bordetella pertussis bacterium. PCR tests are very sensitive and could give a false positive result for other reasons. For more information on best practices when performing PCR testing for pertussis see www.cdc.gov/pertussis/clinical/diagnostic-testing/diagnosis-pcr-bestpractices.html.

Last reviewed: October 31, 2023

In April 2018, the Advisory Committee on Immunization Practices (ACIP) published a compilation of all previous recommendations for the prevention of pertussis, tetanus, and diphtheria (MMWR 2018;678 [RR-2]:1-31). The document can be accessed on the CDC website at www.cdc.gov/mmwr/volumes/67/rr/pdfs/rr6702a1-H.pdf.

In January 2020, ACIP published updated Tdap recommendations, stating that either Td or Tdap may be used in situations where Td only was previously recommended. The document can be accessed on the CDC website at www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6903a5-H.pdf.

Last reviewed: March 31, 2022

All children should receive a series of DTaP at ages 2, 4, and 6 months, with boosters at ages 15–18 months and at 4–6 years. The fourth dose may be given as early as age 12 months if at least 6 months have elapsed since the third dose.

Last reviewed: March 31, 2022

The most current ACIP recommendations for Tdap can be accessed here at www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6903a5-H.pdf.

A listing of the recommendations follows:

  • Tdap can be given regardless of the interval since the last Td was given. There is NO need to wait 2–5 years to administer Tdap following a dose of Td.
  • Adolescents should receive a single dose of Tdap (instead of Td) at the 11–12-year-old visit.
  • Adolescents and adults who have not received a dose of Tdap, or for whom vaccine status is unknown, should receive a single dose of Tdap as soon as feasible. As stated above, Tdap can be administered regardless of interval since the previous Td dose.
  • Children age 7–10 years who are not fully immunized against pertussis (i.e., did not complete a series of pertussis-containing vaccine before their seventh birthday) should receive a single dose of Tdap. If needed, they should complete their series with Td or Tdap. If a Tdap dose is administered at age 10 years or older, the Tdap dose may count as the adolescent Tdap dose.
  • All healthcare personnel, regardless of age, should receive a single dose of Tdap as soon as feasible if they have not previously received Tdap and regardless of the time since the last dose of Td.
  • Pregnant teens and adults should receive Tdap during each pregnancy, preferably between 27- and 36-weeks’ gestation. Mothers who have never received Tdap and who do not receive it during pregnancy should receive it immediately postpartum.
  • Tdap may be administered in any situations where Td only was previously recommended.
  • After receiving an initial dose of Tdap, either Tdap or Td can be used to fulfill the decennial (every 10 years) Td booster dose recommendation.
Last reviewed: March 31, 2022

Vaccine efficacy is 80%–85% following 3 doses of DTaP vaccine. Efficacy data following just 1 or 2 doses are lacking but are likely lower. The most effective way to prevent pertussis in early infancy is to vaccinate the mother between 27 and 36 weeks’ gestation. Antipertussis antibodies generated by the mother’s immune system are passed across the placenta to the fetus. One dose of Tdap should be administered during each pregnancy, preferably between 27 and 36 weeks’ gestation. Available data suggest that vaccinating closer to 27 weeks will maximize passive antibody transfer to the infant. A CDC evaluation found Tdap vaccination during the third trimester of pregnancy prevents 78% of pertussis cases in infants younger than 2 months of age and that maternal vaccination reduces the risk of infant hospitalization for pertussis by 90% (www.cdc.gov/pertussis/pregnant/hcp/vaccine-effectiveness.html).

Last reviewed: March 31, 2022

Yes. The January 2020 ACIP updated statement on the use of Tdap (available at www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6903a5-H.pdf) states that a child who receives a dose of Tdap from age 7–9 years as part of the catch-up series (as in this case), should receive another dose of Tdap at age 11 or 12 years.

Last reviewed: March 31, 2022

The first two doses of Td are valid because they are separated by at least 4 weeks. However, the minimum interval between the second and third doses of tetanus-containing vaccine is 6 calendar months. So, the Td component of the Tdap dose is not valid because it was given only 4 months after the second dose. The pertussis component can be counted as valid. The patient should receive another dose of Td or Tdap 6 months after the invalid Tdap dose.

Last reviewed: March 31, 2022

If the first dose of a tetanus toxoid-containing vaccine is administered before the first birthday, 4 doses are necessary before beginning the 10-year cycle of booster doses. If the first dose is administered after the first birthday, 3 doses are necessary. The final dose should be spaced 6 months from the previous dose.

Last reviewed: March 31, 2022

As of January 2020, ACIP recommends that Td or Tdap may be administered in any situation when only Td vaccine was previously recommended. Someone who received a dose of Tdap at age 11 or 12 years should receive a booster dose of Td or Tdap vaccine ten years later, unless tetanus prophylaxis is required sooner due to an injury or if Tdap vaccination is needed during pregnancy.

Last reviewed: March 31, 2022

Yes. Sometimes ACIP makes recommendations that differ from the FDA-approved package insert indications, and this is one of those instances. ACIP recommendations represent the standard of care for vaccination practice in the United States.

Last reviewed: March 31, 2022

A history of tetanus disease is not a reason to avoid tetanus-containing vaccines. Tetanus disease does not produce immunity because of the very small amount of toxin required to produce illness. As long as your patient has no other contraindications, she should receive Tdap now. If she has no documentation of prior tetanus vaccination, she should receive a complete 3-dose primary series (dose #1 of Tdap, followed by dose #2 of Td or Tdap 4–8 weeks later, and dose #3 of Td or Tdap 6–12 months after dose #2).

Last reviewed: March 31, 2022

No. Tdap should be administered as soon as possible.

Last reviewed: March 31, 2022

If Tdap is administered earlier in pregnancy, it should not be repeated between 27 and 36 weeks’ gestation; only one dose is recommended during each pregnancy.

Last reviewed: October 31, 2023

There are two basic products that can be used in children younger than age 7 years (DTaP and DT) and two that can be used in older children and adults (Td and Tdap). Some people get confused between DTaP and Tdap and others get confused between DT and Td. Here’s a hint to help you remember. The pediatric formulations usually have 3–5 times as much of the diphtheria component than what is in the adult formulation. This is indicated by an upper-case “D” for the pediatric formulation (i.e., DTaP, DT) and a lower case “d” for the adult formulation (Tdap, Td). The amount of tetanus toxoid in each of the products is equivalent, so it remains an upper-case “T.”

Last reviewed: March 31, 2022

There are two different DTaP products currently used in the U.S. for the primary series for children ages 2 months through 6 years (Daptacel [Sanofi] and Infanrix [GSK]). ACIP has recommended that, whenever feasible, healthcare providers should use the same brand of DTaP vaccine for all doses in the vaccination series. If vaccination providers do not know or have available the type of DTaP vaccine previously administered to a child, any DTaP vaccine may be used to continue or complete the series. For vaccines in general, vaccination should not be deferred because the brand used for previous doses is not available or is unknown (see the ACIP’s General Best Practices Guidance for Immunization at www.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html).

Last reviewed: March 31, 2022

If the DTaP brand used for previous doses is not known or not in stock, use whatever DTaP vaccine you have available for all subsequent doses.

Last reviewed: March 31, 2022

If Tdap was inadvertently administered to a child under age 7 years, it should not be counted as either the first, second, or third dose of DTaP. The dose should be repeated with DTaP. Continue vaccinating on schedule. If the dose of Tdap was administered for the fourth or fifth DTaP dose, the Tdap dose can be counted as valid. Please remind your staff to always check the vaccine vial at least 3 times before administering any vaccine.

Last reviewed: March 31, 2022

Yes. In this situation, a second dose of Tdap should be administered at the recommended age of 11 or 12 years.

Last reviewed: March 31, 2022

Yes. The updated ACIP recommendations for the use of Tdap vaccine state that Tdap or Td may be used in any situation where Td only was previously recommended. The updated guidelines are available at www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6903a5-H.pdf.

Last reviewed: March 31, 2022

ACIP recommends that patients needing prophylaxis against tetanus always be given either Td or Tdap rather than TT, as long as there is no contraindication to the other vaccine components. If it’s already been given and the person had not yet received Tdap as an adolescent or adult, you should make certain that he gets Tdap as soon as feasible. If he had received Tdap previously, he can wait until the next scheduled booster dose is due to get his routine Td or Tdap booster.

Last reviewed: March 31, 2022

Single antigen tetanus toxoid should only be used in rare instances, for example when a person has had a documented severe allergic response to diphtheria toxoid.

Last reviewed: March 31, 2022

Tetanus toxoid became commercially available in 1938, but was not widely used until the military began routine vaccination in 1941. Routine administration of tetanus toxoid was recommended by the AAP in 1944. Most World War II military personnel received at least one dose of tetanus toxoid, but civilian use, particularly for adults, did not increase until after the war. You should not assume the tetanus vaccination status for any person based on their age alone. Only a written record is acceptable proof of immunization. People without documentation should be assumed to be unimmunized.

Last reviewed: March 31, 2022

The first step is to inform the parent/patient that you administered the wrong vaccine. Next, follow these guidelines:

  • Tdap given to a child younger than age 7 years as either dose 1, 2, or 3, is not valid. Repeat with DTaP as soon as feasible.
  • Tdap given to a child younger than age 7 years as either dose 4 or 5 can be counted as valid for DTaP dose 4 or 5.
  • Tdap or DTaP given to a fully vaccinated child age 7–9 years: the child should receive the routine adolescent Tdap dose at age 11–12 years.
  • Tdap or DTaP given to a fully vaccinated child age 10 years: count this dose as the routine adolescent Tdap dose recommended at age 11–12 years.
  • DTaP given to an undervaccinated child age 7–9 years: count this dose as a Tdap dose of the catch-up series. The child should receive the routine adolescent booster dose of Tdap at age 11–12 years.
  • DTaP given to an undervaccinated child age 10 years: count this dose as the routine adolescent Tdap dose recommended at age 11–12 years.
  • DTaP given to a person age 11 years or older: count this dose as a routine Tdap dose.

Note that DTaP is neither approved nor recommended for people older than 6 years (except hematopoietic stem cell transplant recipients in some situations; see www.cdc.gov/vaccines/hcp/acip-recs/general-recs/immunocompetence.html).

Last reviewed: March 31, 2022

Yes. The DTaP in the Pentacel can be counted. Although Pentacel is licensed as a 4-dose series and this may represent a fifth dose of Pentacel (in which case it would be off-label use), the dose of DTaP counts as the fifth dose of DTaP.

The same principle applies to Vaxelis (DTaP-IPV-Hib-HepB, MCM), which is licensed for use in children ages 6 weeks through 4 years as a 3-dose series of vaccinations routinely recommended at age 2 months, 4 months, and 6 months. The DTaP in a dose of Vaxelis inadvertently administered after the 5th birthday or as the 4th or 5th dose of DTaP (off-label use) may be counted as valid and does not need to be repeated.

Last reviewed: March 31, 2022

Both of these vaccines provide protection against diphtheria, tetanus, and pertussis. Boostrix (GSK) is licensed for people ages 10 years and older, and Adacel (Sanofi Pasteur) is licensed for people ages 10 through 64 years. The two vaccines also contain a different number of pertussis antigens and different concentrations of pertussis antigen and diphtheria toxoid.

Last reviewed: March 31, 2022

Updated ACIP recommendations for the use of Tdap were published in April 2018 (available at www.cdc.gov/mmwr/volumes/67/rr/pdfs/rr6702a1-H.pdf) and January 2020 (available at www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6903a5-H.pdf). ACIP recommends that all adults age 19 years and older who have not yet received a dose of Tdap receive a single dose. Tdap should be administered regardless of interval since the last tetanus or diphtheria toxoid-containing vaccine (e.g., Td). After receiving Tdap, people should receive Td or Tdap every 10 years for routine booster immunization against tetanus and diphtheria, according to previously published guidelines. A dose of Tdap should be administered during each pregnancy, preferably early in the 27 week through 36 week gestation time period.

Providers should not miss an opportunity to vaccinate adults age 65 and older with Tdap. Providers may administer any Tdap vaccine they have available. When feasible, providers should administer Boostrix (GSK) to adults age 65 and older as it is licensed for this age group. Adacel (Sanofi) is licensed for use in people age 10 through 64. However, ACIP concluded that either vaccine administered to a person age 65 or older is immunogenic and will provide protection. A dose of either vaccine is considered valid.

When a tetanus toxoid-containing vaccine is needed for wound management in a person who has not previously received Tdap, the use of Tdap is preferred over Td.

Last reviewed: March 31, 2022

No. In March 2014, FDA lowered the age indication for Adacel brand Tdap vaccine (Sanofi) from age 11 years to age 10 years. Both Tdap products, Adacel and Boostrix (GSK), now have the same lower age indication.

Last reviewed: March 31, 2022

Tdap vaccination for adolescents is recommended at age 11–12 years. A 10-year-old who is already up to date on diphtheria/tetanus/pertussis vaccines and gets a Tdap vaccine for any reason does not need to receive another Tdap at age 11–12 years.

Last reviewed: March 31, 2022

Yes, you can. Many of the conditions previously considered to be precautions to DTaP (e.g., temperature of 105°F or higher, collapse or shock-like state, persistent crying lasting 3 hours or longer, seizure with or without fever) did not apply to Tdap. These conditions are also no longer considered to be precautions to DTaP. This issue is addressed in the current ACIP statement, available at www.cdc.gov/mmwr/volumes/67/rr/pdfs/rr6702a1-H.pdf, page 3.

Last reviewed: March 31, 2022

Yes. All adolescents should receive one dose of Tdap vaccine to protect them from pertussis, even if they have already received Td. It is important to do this right away (no minimal interval is required), especially if they are in contact with an infant younger than age 12 months, work in a healthcare setting where they have direct contact with patients, or live in a community where pertussis is occurring.

Last reviewed: March 31, 2022

Yes. There is no need to observe any minimum interval between doses of Td and Tdap except when administered as part of a catch-up primary series of tetanus vaccine.

Last reviewed: March 31, 2022

You should use DTaP in children younger than age 7 years. In addition, ACIP recommends giving a dose of Tdap to children age 7–10 years who did not finish a minimum 3-dose series of pertussis-containing vaccines before their 7th birthday or for whom their pertussis vaccine status is unknown. Children age 7–10 who require more than one dose of tetanus-containing vaccine to be up to date may be given either Td or Tdap for doses needed after the initial Tdap dose. Although this is an off-label use of the vaccines, it’s important that you vaccinate these vulnerable children with Tdap as well as any other adolescent or adult who hasn’t received Tdap previously.

Last reviewed: March 31, 2022

This child needs to complete the primary series with 1 dose of Td or Tdap, administered no earlier than 6 months after the Tdap dose given at age 11 years. After that, the child needs a booster dose of Td or Tdap every 10 years. An easy way to determine how to catch up a child is to consult “Recommended Immunization Schedules for Persons Aged 0 Through 18 Years, U.S.” The schedule is approved by CDC, AAP, and AAFP and is released early in each calendar year. It includes a catch-up schedule for children who have fallen behind (see www.cdc.gov/vaccines/schedules/index.html).

Last reviewed: March 31, 2022

Since the first DTaP was received before 12 months of age and one Tdap dose has been given, this person needs one dose of Td or Tdap 6 calendar months after the Tdap dose. A routine Td or Tdap booster should be administered every 10 years. See Immunize.org’s handout: DTaP, Tdap, and Td Catch-up Vaccination Recommendations by Prior Vaccine History and Age: www.immunize.org/catg.d/p2055.pdf.

Last reviewed: March 31, 2022

ACIP recommends the following for the use of Tdap in healthcare personnel:

  • All healthcare personnel (HCP), regardless of age, should receive a single dose of Tdap as soon as feasible if they have not previously received Tdap and regardless of the time since last Td dose.
  • Tdap may be administered in any situations where Td only was previously recommended. After receipt of Tdap, HCP should receive routine booster immunization against tetanus and diphtheria with either Td or Tdap vaccine. Additionally, pregnant HCP should receive a dose of Tdap during each pregnancy.
  • Hospitals and ambulatory-care facilities should provide Tdap for HCP and use approaches that maximize vaccination rates (e.g., education about the benefits of vaccination, convenient access, and the provision of Tdap at no charge).

To view updated recommendations on the use of Td or Tdap in situations where only Td was previously recommended, go to www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6903a5-H.pdf. For details about Tdap and other recommendations for healthcare personnel, go to “Immunization of Health-Care Personnel” (MMWR 2011;60[SS-7]:4-46) at www.cdc.gov/mmwr/pdf/rr/rr6007.pdf.

Last reviewed: March 31, 2022

A CDC study has shown a small increased risk for febrile seizures during the 24 hours after a child receives the inactivated influenza vaccine at the same time as the PCV13 vaccine or DTaP vaccine. However, the risk of febrile seizure with any combination of these vaccines is small and ACIP recommends giving these vaccines at the same visit if indicated. The risk for febrile seizures in children who received PCV15 or PCV20 concurrently with an influenza vaccine has not been studied. See www.cdc.gov/vaccinesafety/concerns/febrile-seizures.html for more information about febrile seizures after vaccination.

Last reviewed: September 10, 2023

There is no minimum period to wait to correct your error. If you had immediately realized that you had mistakenly given the father-to-be Td instead of Tdap, you could have given him the needed Tdap dose at the same visit at which you gave him the erroneous Td dose.

Last reviewed: March 31, 2022

Yes. ACIP recommends a dose of Tdap be given to all adults, including those age 65 years or older.

Last reviewed: March 31, 2022

ACIP recommends the following:

  • All adults age 19 years and older who have not yet received a dose of Tdap should receive a dose.
  • All pregnant people should receive a dose of Tdap during each pregnancy, preferably between 27 and 36 weeks’ gestation. Mothers who have never received Tdap and who do not receive it during pregnancy should receive it immediately postpartum.
  • A person who has not yet received a dose of Tdap can be given a dose of Tdap regardless of the interval since the person last received a tetanus or diphtheria toxoid-containing vaccine.
  • Providers should not miss an opportunity to vaccinate adults age 65 years and older with Tdap. When feasible, give Boostrix to adults age 65 and older. However, either vaccine product (Adacel or Boostrix) provides protection and is considered valid for use in people in this age group.
  • For adults not previously vaccinated with Tdap who need wound management care to prevent tetanus, Tdap is preferred over Td.
  • For adults who have received an initial dose of Tdap, Tdap may be administered in any situations where Td only was previously recommended, including as the decennial (every 10-years) booster dose.
Last reviewed: March 31, 2022

There is no upper age limit for Tdap vaccination. A dose of Tdap is recommended for all adults. In addition, Tdap may be administered in any situations where Td only was previously recommended.

Last reviewed: March 31, 2022

Your understanding of the general Td/Tdap recommendation is correct, and this is the schedule that should be followed for persons 7 years old and older who have never received tetanus-containing vaccine or who cannot provide documentation of prior vaccination. ACIP recommends that Tdap or Td may be used in situations when only Td was previously recommended. Be sure to document doses administered in your state’s immunization information system so other healthcare providers will have access to the record of immunization and a primary series will not need to be repeated in the future.

Last reviewed: March 31, 2022

No. ACIP recommends that people age 11 years and older who have not yet received Tdap receive a dose of Tdap now. ACIP specifies no waiting interval between administering Td and Tdap.

Last reviewed: March 31, 2022

As soon as possible, even if it is the same day.

Last reviewed: March 31, 2022

Vaccination of the parents against pertussis after the baby is born is not optimal, but it may be helpful and should be done if the parents have not previously received Tdap, regardless of when they last received Td vaccination. It takes about 2 weeks after Tdap receipt for the parents to have protection against pertussis. Once the parents have protection, they are is less likely to transmit pertussis to the infant. However, the newborn remains at risk of contracting pertussis from others, including siblings, grandparents, and other caregivers. They should be counseled about the importance of Tdap vaccination of the mother during future pregnancies. See CDC’s web page for more information: www.cdc.gov/pertussis/pregnant/hcp/pregnant-patients.html.

Last reviewed: March 31, 2022

Yes. Tdap can be administered with all other vaccines that are indicated (e.g., meningococcal conjugate vaccine, hepatitis B vaccine, MMR). Each vaccine should be administered at a different anatomic site using a separate syringe.

Last reviewed: March 31, 2022

The DTaP recipient received the appropriate amount of tetanus toxoid and MORE diphtheria toxoid and pertussis antigen than is recommended. Count the dose as Tdap, but take measures to prevent this error in the future. The patient does not need a repeat dose of Tdap.

Last reviewed: March 31, 2022

Revaccination of individuals who are up to date on Tdap immunization with an additional dose of Tdap during a pertussis outbreak is currently not recommended.

Last reviewed: March 31, 2022

Yes. Tdap vaccination is routinely recommended to be given at 27 through 36 weeks’ gestation during every pregnancy. This CDC recommendation is endorsed by the American College of Obstetricians and Gynecologists (ACOG), the American College of Nurse-Midwives (ACNM), the American Academy of Pediatrics (AAP), and the American Academy of Family Physicians (AAFP). Tdap given during one pregnancy will not provide sufficient protection for subsequent pregnancies. In June 2011 ACIP first voted to recommend that pregnant people who have never received the Tdap vaccine be vaccinated to optimize the concentration of maternal antibodies transferred to the fetus. ACIP made this recommendation with the goal of protecting newborns with maternal antibodies and decreasing the risk of transmission of pertussis to infants shortly after birth. In October 2016, ACIP voted to recommend administering Tdap vaccination early in the 27- through 36-week “window” to maximize passive antibody transfer to the infant. Mothers who have never received Tdap and who do not receive it during pregnancy should receive it immediately postpartum.

Fewer babies are hospitalized for pertussis when Tdap is given during pregnancy rather than during the postpartum period. A large U.S. study found an 85% reduction in the risk of pertussis in infants under 2 months of age whose mothers were vaccinated with Tdap at 27 through 36 weeks’ gestation, compared to infants whose mothers were vaccinated in the hospital immediately following delivery.

When a mother gets Tdap during pregnancy, maternal pertussis antibodies transfer to the newborn, protecting the baby against pertussis in early life, before the baby is old enough to have received vaccination with DTaP. Tdap also protects the mother, making it less likely that she will get infected with pertussis during or after pregnancy.

Recommendations for the use of Tdap in pregnancy are covered in detail here: www.cdc.gov/mmwr/volumes/67/rr/pdfs/rr6702a1-H.pdf, pages 22–23.

Last reviewed: March 31, 2022

A CDC evaluation found Tdap vaccination during the third trimester of pregnancy prevents 78% of pertussis cases in infants younger than 2 months of age. These findings are similar to other studies from the United Kingdom and the United States that suggest that vaccinating the mother during pregnancy is highly effective at protecting infants against pertussis.

When infants do get pertussis, their infection is less severe if their mother received Tdap during pregnancy. A CDC evaluation found maternal vaccination is 90% effective at preventing infant hospitalization from pertussis. Another U.S. study showed that infants whose mothers got Tdap during pregnancy had a significantly lower risk of hospitalization and shorter hospital stays. That same study showed that no infants born to vaccinated mothers required intubation or died of pertussis.

Links to published research on Tdap vaccination during pregnancy are available here: www.cdc.gov/pertussis/pregnant/research.html.

Last reviewed: March 31, 2022

Yes. If there is no written documentation that she received a dose of Tdap prior to or during pregnancy, a dose of Tdap should be administered to her immediately postpartum.

Last reviewed: March 31, 2022

The recommended schedule for the primary series given to an unvaccinated person is dose 1 now, dose 2 in 4 weeks, and dose 3 in 6 to 12 months. Tdap should replace at least 1 dose of Td, preferably between 27 and 36 weeks’ gestation to maximize the maternal antibody response and passive antibody transfer to the infant.

Last reviewed: March 31, 2022

Yes. ACIP looked into this issue and included related information in its recommendations published in MMWR on February 22, 2013 (www.cdc.gov/mmwr/preview/mmwrhtml/mm6207a4.htm). ACIP reviewed available data on birth statistics and found that among those in the U.S. who have more than one pregnancy, a very small percentage (2.5%) have an interval of 12 months or less between births. The majority of people who have two pregnancies have an interval of 13 months or more between births. Approximately 5% of mothers have four or more pregnancies. ACIP concluded that (1) the interval between subsequent pregnancies is likely to be longer than is the persistence of maternal anti-pertussis antibodies, (2) most mothers would receive only 2 doses of Tdap, and (3) a small proportion of mothers would receive 4 or more doses.

A theoretical risk exists for severe local reactions (e.g., Arthus reactions, whole limb swelling) for pregnant people who have multiple, closely spaced pregnancies. However, the frequency of side effects depends on the vaccine’s antigen content and product formulation, as well as on preexisting maternal antibody levels related to the interval since the last dose and the number of doses received. The risk for severe adverse events has likely been reduced with current vaccine formulations (including Tdap), which contain lower doses of tetanus toxoid than did older vaccine formulations. ACIP believes the potential benefit of preventing pertussis morbidity and mortality in infants outweighs the theoretical concerns of possible severe adverse events in mothers.

Last reviewed: March 31, 2022

No, it is not recommended to give another dose of Tdap in such cases. Optimal timing for Tdap administration is between 27 and 36 weeks’ gestation because that stage of pregnancy is best for transplacental antibody movement to the fetus.

More information is available at www.cdc.gov/mmwr/volumes/67/rr/pdfs/rr6702a1-H.pdf, pages 22–23.

Last reviewed: March 31, 2022

ACIP does not recommend repeated doses of Tdap for fathers or other family members or caregivers of infants during every pregnancy. The recommendation for Tdap vaccination with each pregnancy to optimize immunity for the infant applies only to the pregnant mother.

The practice of “cocooning” infants by making a particular effort to vaccinate caregivers who have not received Tdap vaccination has been recommended by ACIP since 2005; however, the practice has been difficult to implement fully and may not be effective alone as a strategy for protecting newborns from pertussis exposure. The combined strategy of Tdap vaccination during each pregnancy, cocooning, and administering the childhood DTaP series on schedule provides the best protection to the infant.

Last reviewed: March 31, 2022

To maximize maternal antibody response and passive antibody transfer to the infant, the optimal time to administer Tdap is between 27 and 36 weeks’ gestation, preferably during the early part of that window. However, Tdap can be administered at any time during pregnancy.

Last reviewed: March 31, 2022

While the mother should have been given Tdap rather than Td, the Tdap dose may be given at any interval since the Td dose was given and preferably between 27 and 36 weeks’ gestation.

Last reviewed: March 31, 2022

Yes. ACIP recommends a dose of Tdap during each pregnancy irrespective of the patient’s prior history of receiving Tdap. To maximize the maternal antibody response and passive antibody transfer to the infant, optimal timing for Tdap administration is between 27 and 36 weeks’ gestation (preferably early in that window). For more information, see www.cdc.gov/mmwr/volumes/67/rr/pdfs/rr6702a1-H.pdf, pages 22–23.

Last reviewed: March 31, 2022

No. Tdap is an inactivated vaccine and may be administered at the same time as Rhogam (in a separate site with a separate syringe).

Last reviewed: March 31, 2022

Children, age 7 years and older, and adults who have never received tetanus-containing vaccines, or whose vaccination history is unknown, should receive the 3-dose series. In this situation, ACIP recommends Tdap for dose #1, followed 4 weeks later by Td or Tdap for dose #2, followed at least 6 months later by Td or Tdap for dose #3. The amount of protection provided by one or more doses of Tdap in a person who has not previously received pertussis vaccine is not known. Following the primary series, booster doses of Td or Tdap should be given every 10 years thereafter.

Last reviewed: March 31, 2022

The fourth dose of DTaP may be given as early as age 12 months if at least 6 months have passed since the third dose.

Last reviewed: March 31, 2022

You should try to achieve at least 4 total doses. Give additional doses of DTaP with 4-week intervals until you achieve 3 total doses. Then, if 6 months pass and the child has not turned seven years old, give the 4th dose of DTaP: if the child has turned seven years old, you may administer a dose of Tdap vaccine at that time.

Last reviewed: March 31, 2022

Although the child would be considered complete for tetanus and diphtheria toxoids, she is not complete for pertussis vaccine. DTaP vaccines are FDA-approved only through age 6 years so no more DTaP doses are recommended.

However, ACIP recommends that children age 7–10 years who are not fully vaccinated against pertussis (defined as 5 doses of DTaP or 4 doses of DTaP if the fourth dose was administered on or after the fourth birthday) and who do not have a contraindication to pertussis vaccine should receive a single dose of Tdap to provide protection against pertussis. If the child in this case is age 7–9 years at the time of Tdap vaccination, the next dose due will be the routine adolescent dose of Tdap at age 11 or 12 years. If the child is age 10, the dose counts as the adolescent dose and no additional dose at age 11 or 12 years is recommended.

Last reviewed: March 31, 2022

If DTaP #4 is given with at least a 4-month interval after DTaP #3, it does not need to be repeated. The minimum age of 12 months for the fourth dose must be met. Decreasing the interval to less than 6 months, however, is not recommended.

Last reviewed: March 31, 2022

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