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Notice to Readers: Resumption of Routine Schedule for Tetanus and Diphtheria Toxoids

The supply of adult tetanus and diphtheria toxoids (Td) in the United States has become sufficient to permit the resumption of the routine schedule for Td use as recommended by the Advisory Committee on Immunization Practices (1,2). Adolescents and adults for whom routine Td booster doses were deferred should be recalled by their health-care providers to receive the delayed dose. School attendance provisions requiring students to have received a Td booster at age >11 years can be reinstituted.

The Td shortage began in the last quarter of 2000 and resulted from 1) decreased production in 2000 by both U.S. manufacturers (Wyeth Lederle [Pearl River, New York] and Aventis Pasteur [Swiftwater, Pennsylvania]), 2) the decision by Wyeth Lederle to cease Td production in 2001, and 3) the 11-month period required for vaccine production, which led to a lag before increased Td supplies were available from the remaining manufacturer distributing vaccine nationally (Aventis Pasteur) (3--5). The amount of Td distributed nationally decreased 40% during 2001--2002, compared with preshortage distribution levels (Biological Surveillance System, unpublished data, 2002). To ensure vaccine availability for priority indications (3), CDC recommended in May 2001 that all routine Td boosters in adolescents and adults be deferred and that health-care providers record the names of patients whose booster doses were delayed for call-back once Td supplies are restored (5). Health-care providers should review the vaccination status of their patients and administer Td and other indicated vaccines as appropriate.


  1. Immunization Practices Advisory Committee. Diphtheria, tetanus, and pertussis: recommendations for vaccine use and other preventive measures---recommendations of the Immunization Practices Advisory Committee (ACIP). MMWR 1991;40(No. RR-10).
  2. CDC. Immunization of adolescents: recommendations of the Advisory Committee on Immunization Practices, the American Academy of Pediatrics, the American Academy of Family Physicians, and the American Medical Association. MMWR 1996;45(No. RR-13).
  3. CDC. Shortage of tetanus and diphtheria toxoids. MMWR 2000;49:1029--30.
  4. CDC. Update on the supply of tetanus and diphtheria toxoids and of diphtheria and tetanus toxoids and acellular pertussis vaccine. MMWR 2001;50:189--90.
  5. CDC. Deferral of routine booster doses of tetanus and diphtheria toxoids for adolescents and adults. MMWR 2001;50:418,427.

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