Provider Information: Tdap VIS
These provider guidelines supplement the VIS and summarize relevant ACIP recommendations; include more detailed information about indications, schedules, and precautions; and contain other information giving providers a quick reference to help address common patients' questions.
Boostrix is approved for ages 10 years and older, and Adacel for ages 11 through 64 years. However, ACIP has harmonized its recommendations for the two vaccines. One lifetime dose of Tdap is recommended for people 11 years of age and older. Pregnancy is an exception to the one-dose recommendation (see below).
- Age 11 or 12: Recommended age.
- Age 13 through 19: Catch-up if not vaccinated at routine visit.
- Age 19 and older: One dose if not previously vaccinated. This dose may be given regardless of the interval since the last dose of tetanus or diphtheria toxoid containing vaccine.
The one lifetime dose of Tdap should be followed by routine 10-year doses of Td.
People with a history of pertussis disease should still receive a dose of Tdap.
- Children 7 through 10 years
Children between the 7th and 11th birthdays who are not fully vaccinated against pertussis ("fully vaccinated" is 5 doses of DTaP, or 4 doses of DTaP if the 4th dose was given on or after the 4th birthday) should receive a single dose of Tdap. This dose counts as the routine 11-12 year dose.
- Pregnant Women
In 2011, ACIP recommended a dose of Tdap for pregnant woman who had not been previously vaccinated with Tdap.
In February 2013, ACIP published updated recommendations for pregnant women, stating that:
- A dose of Tdap should be given to a pregnant woman during each pregnancy, regardless of the patient’s previous history of receiving Tdap.
- The optimal timing of this dose is between 27 and 36 weeks of gestation – but it may be given at any time during the pregnancy.
- This dose should be given regardless of the interval since any previous dose of Tdap.
- A woman who did not get a dose of Tdap during her pregnancy, and if never received a dose of Tdap in the past, should get a dose of Tdap immediately post-partum. Women previously vaccinated with Tdap should not get this dose.
- A pregnant woman who is due for a routine 10-year Td booster, or for whom tetanus toxoid is indicated for wound management, should receive Tdap.
The rationale for this dose, and for its timing, is to maximize the maternal antibody response and passive antibody transfer to the infant.
- Wound Management: Anyone requiring tetanus toxoid for wound management, who has never received a dose of Tdap, should be given Tdap. [Exception: A pregnant women needing tetanus toxoid for wound management should always get Tdap (see above).]
- Td Booster: Anyone due for a 10-year Td booster, who has never received a dose of Tdap, should be given Tdap. [Exception: A pregnant women requiring a 10-year booster should always get Tdap (see above).]
- Primary Series: Any adolescent or adult with an incomplete or unknown primary series of tetanus, diphtheria, or pertussis vaccines should complete a series of three doses of tetanus-diphtheria containing vaccine, one dose of which (ideally the first) should be Tdap. The recommended interval between doses 1 and 2 is at least 4 weeks, and between doses 2 and 3 is 6-12 months.
Contraindications and Precautions
There are two absolute contraindications for use of Tdap:
- History of anaphylaxis to any component of the vaccine.
Components of the Tdap vaccines can be found in the excipient table [50KB, 3 pages] or in the manufacturers' package insert. Because of the importance of tetanus vaccination, persons with a history of anaphylaxis to components included in any Tdap or Td vaccines should be referred to an allergist to determine whether they have a specific allergy to tetanus toxoid and can safely receive tetanus toxoid vaccinations.
- A history of encephalopathy (e.g., coma or prolonged seizures), not attributable to another identifiable cause, within 7 days of administration of any pertussis-containing vaccine. These persons should receive Td.
- Guillain-Barré syndrome within 6 weeks after a previous dose of tetanus-containing vaccine. (If a decision is made to vaccinate with tetanus toxoid, Tdap is preferred over Td, if otherwise indicated.)
- Tdap should generally be deferred for:
- Moderate or severe acute illness.
- Unstable neurologic condition.
- History of an Arthus reaction following a previous tetanus and/or diphtheria containing vaccine.
Some conditions that are contraindications or precaution for DTaP vaccine are not contraindications or precautions for Tdap.
For more detailed information, see the following ACIP recommendations:
- Preventing Tetanus, Diphtheria, and Pertussis Among ADOLESCENTS: Use of Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccines. MMWR. 2006;55(RR03);1-34.
- Preventing Tetanus, Diphtheria, and Pertussis Among ADULTS: Use of Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccines. MMWR. 2006;55(RR17);1-33.
- Updated Recommendations for Use of Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis (Tdap) Vaccine in Adults Aged 65 Years and Older, ACIP 2012. MMWR. 2012;61(25);468-470.
- Updated Recommendations for Use of Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis (Tdap) Vaccine from the Advisory Committee on Immunization Practices, 2010. MMWR. 2011;60(01);13-15.
- Updated Recommendations for Use of Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccine (Tdap) in Pregnant Women and Persons Who Have or Anticipate Having Close Contact with an Infant Aged <12 Months — Advisory Committee on Immunization Practices (ACIP), 2011. MMWR. 2011;60(41);1424-1426.
- Updated Recommendations for Use of Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis Vaccine (Tdap) in Pregnant Women — Advisory Committee on Immunization Practices (ACIP), 2012. MMWR. 2013;62(07);131-135.
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