APPENDIX A. Summary of Recommendations for Tetanus Toxoid,
Reduced Diphtheria Toxoid and Acellular Pertussis Vaccine (Tdap) Use Among Adults
The following recommendations for a single dose of Tdap
(ADACEL®) apply to adults aged 19--64 years who have not
yet received Tdap. Adults should receive a decennial booster with Td beginning 10 years after receipt of Tdap
Routine: Adults should receive a single dose of Tdap to replace a single dose of Td for booster immunization
against tetanus, diphtheria, and pertussis if they received their most recent tetanus toxoid-containing vaccine (e.g., Td)
>10 years earlier.
Short intervals between Td and Tdap: Tdap can be administered at an interval <10 years since receipt of the
last tetanus toxoid-containing vaccine to protect against pertussis. The safety of intervals as short as approximately 2
years between administration of Td and Tdap is supported by a Canadian study of children and adolescents. The dose of
Tdap replaces the next scheduled Td booster.
Prevention of pertussis among infants aged <12 months by vaccinating adult
contacts: Adults who have or who anticipate having close contact with an infant aged <12 months (e.g., parents, grandparents, child-care providers,
or health-care providers) should receive a single dose of Tdap. An interval as short as 2 years since the
most recent tetanus toxoid-containing vaccine is suggested; shorter intervals can be used. Ideally, Tdap should be administered at least 2
weeks before beginning close contact with the infant. Women should receive a dose of Tdap in the immediate postpartum period
if they have not previously received Tdap. Any woman who might become pregnant is encouraged to receive a single dose
Vaccination of health-care
personnel (HCP): HCP in hospitals and ambulatory care settings who have direct
patient contact should receive a single dose of Tdap as soon as feasible if they have not previously received Tdap. An interval
as short as 2 years because the last dose of Td is recommended. Other HCP should receive a single dose of Tdap
according to the routine recommendation; they are encouraged also to receive Tdap at an interval as short as 2 years. Priority
should be given to vaccination of HCP who have direct contact with infants aged <12 months. Hospitals and
ambulatory-care facilities should provide Tdap for HCP and use approaches that maximize vaccination rates.
Simultaneous administration: Tdap should be administered with other vaccines that are indicated during the same
visit when feasible. Each vaccine should be administered using a separate syringe at different anatomic sites.
History of pertussis: Adults with a history of pertussis generally should receive Tdap according to the
Tetanus prophylaxis in wound
management: Adults aged 19--64 years who require a tetanus toxoid-containing
vaccine as part of wound management should receive Tdap instead of Td if they have not previously received Tdap. If Tdap is
not available or was administered previously, Td should be administered.
Incomplete or unknown vaccination
history: Adults who have never received tetanus and diphtheria toxoid-containing vaccine should receive a series of three vaccinations. The preferred schedule is a single dose of Tdap followed by Td
>4 weeks later and a second dose of Td 6--12 months later. Tdap can substitute for Td for any one of the 3 doses in
Pregnancy: Pregnancy is not a contraindication for Tdap or Td vaccination. Guidance on the use of Tdap
during pregnancy is published separately
Adults aged >65 years: Tdap is not licensed for use among adults aged
>65 years. The safety and immunogenicity
of Tdap among adults aged >65 years was not studied during U.S. prelicensure trials.
Contraindications to Tdap
History of serious allergic reaction (i.e., anaphylaxis) to vaccine components.
History of encephalopathy (e.g., coma, prolonged seizures) not attributable to an identifiable cause within 7 days
of administration of a pertussis vaccine.
Precautions and reasons to defer Tdap:
<6 weeks after a previous dose of a tetanus toxoid-containing vaccine;
Moderate to severe acute illness;
Unstable neurological condition; and
History of Arthus hypersensitivity reaction to a tetanus toxoid-containing vaccine administered <10 years previously.
Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of
Health and Human Services.References to non-CDC sites on the Internet are
provided as a service to MMWR readers and do not constitute or imply
endorsement of these organizations or their programs by CDC or the U.S.
Department of Health and Human Services. CDC is not responsible for the content
of pages found at these sites. URL addresses listed in MMWR were current as of
the date of publication.
All MMWR HTML versions of articles are electronic conversions from ASCII text
into HTML. This conversion may have resulted in character translation or format errors in the HTML version.
Users should not rely on this HTML document, but are referred to the electronic PDF version and/or
the original MMWR paper copy for the official text, figures, and tables.
An original paper copy of this issue can be obtained from the Superintendent of Documents,
U.S. Government Printing Office (GPO), Washington, DC 20402-9371; telephone: (202) 512-1800.
Contact GPO for current prices.
**Questions or messages regarding errors in formatting should be addressed to