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Diphtheria, Tetanus, and Pertussis Vaccine Recommendations

One of the Recommended Vaccines by Disease

Below are summaries of recommendations from CDC’s Advisory Committee on Immunization Practices (ACIP). For the full text of the recommendations, see DTaP ACIP Vaccine Recommendations and Tdap/Td ACIP Vaccine Recommendations.

Routine Vaccination of Infants and Children, Adolescents, Pregnant Women, and Adults

CDC recommends diphtheria, tetanus, and acellular pertussis vaccination (DTaP for those younger than 7 years of age, and Tdap or Td for those 7 years or older) across the lifespan.

  • Infants and children should receive 5 doses of DTaP, usually administered at 2, 4, and 6 months, 15 through 18 months, and 4 through 6 years of age. DT can be used for infants and children who should not receive acellular pertussis-containing vaccines.
  • Adolescents should receive a single dose of Tdap, preferably at 11 to 12 years of age.
  • Pregnant women should receive a single dose of Tdap during every pregnancy, preferably at 27 through 36 weeks gestation. Tdap is recommended only in the immediate postpartum period before discharge from the hospital or birthing center for new mothers who have never received Tdap before or whose vaccination status is unknown.
  • Adults should receive a single dose of Td every 10 years. For adults who did not receive Tdap as an adolescent, a dose of Tdap can replace one of the 10-year Td booster doses. (Note: When feasible, Boostrix® should be used for adults 65 years and older; however, either vaccine product administered to a person 65 years or older may be used. Providers should not miss an opportunity to vaccinate persons aged 65 years and older with Tdap. Therefore, providers may administer the Tdap vaccine they have available.)

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Vaccination of Healthcare Personnel

A single dose of Tdap is recommended for healthcare personnel who have not previously received Tdap regardless of the time since their most recent Td vaccination. See Evaluating Revaccination of Healthcare Personnel for additional information.

Catch-up Guidance for Children 4 Months through 18 Years

The following “job-aid” provides catch-up guidance for diphtheria, tetanus, and pertussis vaccination for children 4 months through 18 years of age, including detailed scenarios by age group and previous doses of vaccine received. This should assist healthcare professionals in interpreting Figure 2 of the Childhood/Adolescent Immunization catch-up schedule.

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Contraindications and Precautions

Any Diphtheria Toxoid-, Tetanus Toxoid-, or Acellular Pertussis-containing Vaccine

Diphtheria, tetanus, and pertussis vaccines should not be administered to:

  • Patients who have had a severe allergic reaction (e.g., anaphylaxis) after a previous dose
  • A person who has a severe allergy to any vaccine component

Diphtheria, tetanus, and pertussis vaccines may be administered, if the provider and parent or patient deems the benefits of vaccination to outweigh the risks, to patients who have:

  • A moderate or severe acute illness with or without fever
  • Had Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of tetanus toxoid-containing vaccine
  • A history of arthus-type hypersensitivity reactions after a previous dose of tetanus or diphtheria toxoid-containing vaccine; defer vaccination until at least 10 years have elapsed since the last tetanus-toxoid containing vaccine

Guidance Specific to Acellular Pertussis-containing Vaccines

Acellular pertussis-containing vaccines should not be administered to:

  • Patients who developed encephalopathy (e.g., coma, decreased level of consciousness, prolonged seizures) not attributable to another identifiable cause within 7 days of administration of a previous dose of DTP, DTaP, or Tdap

Acellular pertussis-containing vaccines may be administered for the following conditions once a treatment regimen has been established and the condition has stabilized:

  • Progressive or unstable neurologic disorder (including infantile spasms for DTaP)
  • Uncontrolled seizures
  • Progressive encephalopathy

Guidance Specific to DTaP Only

DTaP may be administered, if the provider and parent deems the benefits of vaccination to outweigh the risks, to patients who had:

  • Temperature of 105°F or higher (40.5°C or higher) within 48 hours after vaccination with a previous dose of DTP/DTaP
  • Collapse or shock-like state (i.e., hypotonic hyporesponsive episode) within 48 hours after receiving a previous dose of DTP/DTaP
  • Seizure within 3 days after receiving a previous dose of DTP/DTaP
  • Persistent, inconsolable crying lasting 3 or more hours within 48 hours after receiving a previous dose of DTP/DTaP

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