Diphtheria, Tetanus, and Pertussis Vaccine Recommendations
Tdap Use While Td Supplies Are Limited
Following an interruption in the distribution of TDVAX, CDC has issued temporary guidance on using Tdap vaccine in lieu of Td vaccine.
DT Vaccine Discontinuation
In 2023, Sanofi Pasteur, Inc. stopped manufacturing the diphtheria and tetanus toxoids absorbed vaccine, commonly known as DT. Discussions are underway regarding updated vaccine recommendations for infants and children who should not receive acellular pertussis-containing vaccines.
Following an interruption in the distribution of TDVAX that occurred between December 2022 and early March 2023, the national supply and ordering for Td vaccine in the United States is being closely monitored. Temporary ordering controls have been put into place to mitigate a potential supply constraint for Td vaccine through June 2023.
To assist providers during this period, CDC developed the following guidance:
- Tdap vaccine is an acceptable alternative to Td vaccine, including when a tetanus booster is indicated for wound management. The only time Tdap vaccine is not an acceptable alternative is in very rare cases where a person has a specific contraindication to pertussis-containing vaccines.
- The limited supply of Td vaccine needs to be preserved for those with a contraindication to receiving pertussis-containing vaccines.
- CDC recommends that vaccination providers transition to use of Tdap vaccine in lieu of Td vaccine whenever possible. This recommendation will remain in place until the period of temporary ordering controls for Td vaccine has been resolved.
Summary of Recommendations
Below are summaries of recommendations from CDC’s Advisory Committee on Immunization Practices (ACIP). For the full text of the recommendations, see DTaP/Tdap/Td ACIP Vaccine Recommendations.
Routine Vaccination of Infants, Children, Adolescents, Pregnant Women, and Adults
CDC recommends diphtheria, tetanus, and acellular pertussis vaccination across the lifespan. Children younger than 7 years of age receive DTaP or DT, while older children and adults receive Tdap and Td.
- Give infants and children 5 doses of DTaP. Give one dose at each of these ages: 2 months, 4 months, 6 months, 15 through 18 months, and 4 through 6 years. Use DT for infants and children who should not receive acellular pertussis-containing vaccines.
- Give adolescents a single dose of Tdap, preferably at 11 to 12 years of age.
- Give women a single dose of Tdap during every pregnancy, preferably during the early part of gestational weeks 27 through 36. CDC only recommends Tdap in the immediate postpartum period for new mothers who did not receive Tdap during their current pregnancy and did not receive a prior dose of Tdap ever (i.e., during adolescence, adulthood, or a previous pregnancy). If a woman did not receive Tdap during her current pregnancy but did receive a prior dose of Tdap, then she should not receive a dose of Tdap postpartum.
- Give adults who have never received Tdap a single dose of Tdap. This can be given at any time, regardless of when they last got Td. This should be followed by either a Td or Tdap booster every 10 years. (Note: When feasible, Boostrix® should be used for adults 65 years or older; however, either vaccine product administered to a person 65 years or older is valid. Providers should not miss an opportunity to vaccinate persons aged 65 years or older with Tdap. Therefore, providers may administer the Tdap vaccine they have available.)
Vaccination of Healthcare Personnel
CDC recommends a single dose of Tdap for healthcare personnel who have never received Tdap regardless of the time since their most recent Td vaccination. After receiving 1 dose of Tdap, healthcare personnel should receive a dose of Td or Tdap every 10 years. See Evaluating Revaccination of Healthcare Personnel for additional information.
Catch-up Guidance for Children 4 Months through 18 Years
The following “job-aids” provide catch-up guidance for diphtheria, tetanus, and pertussis vaccination for children 4 months through 18 years of age. They include detailed scenarios by age group and previous number of doses received. These should assist healthcare professionals in interpreting Figure 2 of the Childhood/Adolescent Immunization Catch-up Schedule.
4 Months through 6 Years of Age
7 through 18 Years of Age
Contraindications and Precautions
Any Diphtheria Toxoid-, Tetanus Toxoid-, or Acellular Pertussis-containing Vaccine
You should not administer diphtheria, tetanus, and pertussis vaccines 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
You may administer diphtheria, tetanus, and pertussis vaccines if you and the parent or patient deem 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 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
You should not administer acellular pertussis-containing vaccines 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
You may administer acellular pertussis-containing vaccines to patients with 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
- ACIP—Vaccines for Children (VFC) Resolution
- Contraindications and Precautions to Commonly Used Vaccines
- Contraindications and Precautions
From the Pink Book’s General Recommendations on Immunization
- Diphtheria, Tetanus, and Pertussis Vaccine Information Statements
- DTaP (English / Other Languages)
- Td (English / Other Languages)
- Tdap (English / Other Languages)
- Evaluating Revaccination of Healthcare Personnel with Tdap: Factors to Consider
- Guidelines for Vaccinating Pregnant Women
- Healthcare Personnel Vaccination Recommendations [1 page]
- Immunization of Health-Care Personnel: Recommendations of the Advisory Committee on Immunization Practices (ACIP)
- Pertussis Vaccination: Summary of Vaccine Recommendations
- Standing Orders for Administering Diphtheria, Tetanus, and Pertussis Vaccines
Immunization Action Coalition