As with all vaccines, a severe allergic reaction (e.g., anaphylaxis) to a vaccine component or to a prior dose is a contraindication to further doses of that vaccine. A history of encephalopathy within 7 days of receiving a previous pertussis-containing vaccine that is not due to another identifiable cause is a contraindication to both DTaP and Tdap.
Ask the Experts: Tetanus: Contraindications & Precautions
Precautions to these vaccines include:
- A history of Guillain-Barré syndrome (GBS) within 6 weeks of receiving a tetanus toxoid-containing vaccine
- A history of Arthus-type hypersensitivity reaction after receiving a previous tetanus or diphtheria toxoid-containing vaccine (defer vaccination until at least 10 years have elapsed since the last tetanus toxoid-containing vaccine)
- A moderate or severe acute illness with or without fever
- For pertussis-containing vaccines (DTaP and Tdap only): an additional precaution is a progressive or unstable neurologic disorder, including infantile spasms, uncontrolled seizures or progressive encephalopathy. DTaP and Tdap should be deferred until the neurologic status of the patient is clarified and stabilized.
Yes. Mothers who have never received Tdap and who did not receive it during pregnancy should receive it immediately postpartum or as soon as possible thereafter. Breastfeeding does not decrease the immune response to routine childhood vaccines and is not a contraindication for any vaccine except smallpox. Breastfeeding is a precaution for yellow fever vaccine and the vaccine can be given for travel when indicated.
Tdap is an inactivated vaccine and may be given at the same prenatal visit with RhoGam. For more information on this topic, including the timing for the use of other vaccines with regards to RhoGam, see ACIP’s “General Best Practice Guidelines” for Immunization at www.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html for more information on this issue.
A family history of a neurologic disorder or reaction to a pertussis-containing vaccine is not a contraindication to vaccination of this child. The child should receive additional DTaP doses as indicated in the catchup schedule.
This depends on the contraindication or precaution the person had to DTaP.
The contraindications are (1) severe allergic reaction (e.g., anaphylaxis after a previous dose or to a vaccine component) and (2) encephalopathy within 7 days of a previous dose of DTaP or DTP; in these cases, give Td instead of Tdap.
The precautions for which Tdap vaccination may be delayed or for which the balance of individual risks and benefits should be weighed are
- Moderate or severe acute illness (defer until recovered);
- History of an Arthus-type hypersensitivity reaction following a previous dose of tetanus or diphtheria toxoid-containing vaccines, including MenACWY-D or MenACWY-TT (Menactra or MenQuadfi, Sanofi Pasteur) (defer vaccination until at least 10 years have elapsed since the last tetanus-toxoid-containing vaccine);
- Guillain-Barré syndrome (GBS) 6 weeks or sooner after a previous dose of tetanus toxoid-containing vaccine; and
- Progressive or unstable neurologic disorder, uncontrolled seizures or progressive encephalopathy until a treatment regimen has been established and the condition has stabilized.
ACIP has published a Guide to Vaccine Contraindications and Precautions in its “General Best Practice Guidelines for Immunization”, available at www.cdc.gov/vaccines/hcp/acip-recs/general-recs/contraindications.html.
Controlled epilepsy is not a contraindication to receipt of Tdap. To access Immunize.org’s table of vaccine contraindications and precautions, go to www.immunize.org/catg.d/p3072a.pdf. CDC also makes this information available at www.cdc.gov/vaccines/hcp/acip-recs/general-recs/contraindications.html.
An infant who experiences an afebrile seizure following a dose of DTaP requires further evaluation. An infant with a recent seizure or an evolving neurologic condition should not receive further doses of DTaP or DT until the condition has been evaluated and stabilized. Other indicated vaccines may be administered on schedule. To assure that the child is at least protected against tetanus and diphtheria, the decision to give either DTaP or DT should be made no later than the first birthday.
Usually, an “allergy” to tetanus toxoid is anecdotal and not a true anaphylactic reaction to modern tetanus toxoid. Patients often claim to be allergic to tetanus toxoid because of (1) an exaggerated local reaction (which is not an allergy) or (2) a reaction to a tetanus vaccine received many years ago (probably serum sickness from equine tetanus antitoxin). A history of one of these events is not a contraindication to modern tetanus toxoid, Td, or Tdap.
Only an allergist-confirmed severe allergy (e.g., anaphylaxis) to tetanus toxoid should be accepted as a valid contraindication to a modern tetanus-toxoid containing product. A person who has an allergist-confirmed anaphylactic allergy to tetanus toxoid has no recourse for pertussis vaccination because no single-antigen pertussis vaccine is licensed for use in the United States.
Tetanus toxoid has never contained horse serum or protein. Equine tetanus antitoxin (horse derived) was the only product available for the prevention of tetanus prior to the development of tetanus toxoid in the 1940s. Equine antitoxin was also used for passive post-exposure prophylaxis of tetanus (e.g., after a tetanus-prone wound) until the development of human tetanus immune globulin in the late 1950s. Equine tetanus antitoxin has not been available in the U.S. for at least 40 years.