Diphtheria, Tetanus, and Pertussis Vaccine Recommendations
Production of one tetanus and diphtheria (Td) vaccine, TdVaxTM, has been discontinued. As a result, CDC anticipates that the supply of Td vaccine in the U.S. market will be constrained during 2024. CDC has developed guidance to help vaccination providers.Read the guidance
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.
CDC recommends diphtheria, tetanus, and acellular pertussis vaccination across the lifespan. Children younger than 7 years of age receive DTaP, while older children and adults receive Tdap and Td.
Infants and Children
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
- 4 through 6 years
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 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.
Production of one Td vaccine has been discontinued. Read CDC’s guidance on using Tdap in lieu of Td whenever possible while Td supplies are constrained.
When feasible, Boostrix® should be used for adults 65 years or older. Adacel® is only approved for use up through 64 years of age. However, 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 and it will be valid.
HCP should follow the same immunization guidance provided for all adults. There are no unique vaccination recommendations for HCP with Tdap or Td.
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 Table 2 of the Child and Adolescent Immunization Catch-up Schedule.
4 Months through 6 Years of Age
7 through 18 Years of Age
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
CDC’s guidance on using Td for infants and children who should not receive acellular pertussis-containing vaccines.
Historically, two tetanus and diphtheria (Td) vaccine products have been available for use in the United States:
- TdVaxTM, manufactured by MassBiologics
- Tenivac®, manufactured by Sanofi
MassBiologics has discontinued production of TdVaxTM, which is exclusively distributed by Grifols. Sanofi is taking steps to augment their available U.S. supply of Tenivac®. Despite these efforts, it’s anticipated that the supply of Td vaccine in the U.S. market will be constrained during 2024.
Temporary ordering controls are in place in the public and private sectors to help manage the gap in supply. Diphtheria, tetanus, and acellular pertussis (Tdap) vaccines are available without supply constraints at this time.
Guidance for vaccination providers
The limited supply of Td vaccine needs to be preserved for those with a contraindication to receiving pertussis-containing vaccines. To assist vaccination providers, CDC has developed the following guidance:
- Transition to use of Tdap vaccine in lieu of Td vaccine whenever possible while Td vaccine supplies are constrained.
- Tdap vaccine is an acceptable alternative to Td vaccine, including when a tetanus booster is indicated for wound management.
- Tdap vaccine isn’t an acceptable alternative only when a person has a specific contraindication to pertussis-containing vaccines, which is very rare.
This guidance will remain in place until the period of temporary ordering controls for Td vaccine ends.
- About Young Children with a Contraindication to Pertussis-Containing Vaccines
- 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
- 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