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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 (33).

  • 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 of Tdap.
  • 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.

Special Situations

  • History of pertussis: Adults with a history of pertussis generally should receive Tdap according to the routine recommendations.
  • 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 the series.
  • Pregnancy: Pregnancy is not a contraindication for Tdap or Td vaccination. Guidance on the use of Tdap during pregnancy is published separately (236).
  • 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:
  • Guillain-Barré syndrome <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.

Reporting Adverse Events After Vaccination:

All clinically significant adverse events should be reported to VAERS, even if a causal relation to vaccination is uncertain. VAERS reporting forms and information are available electronically at or by telephone (800) 822-7967. Providers are encouraged to report electronically at

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Date last reviewed: 12/8/2006


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