Diphtheria, Tetanus, and Whooping Cough Vaccination

What Everyone Should Know

Key Facts

Vaccines used in the United States today against diphtheria and tetanus (i.e., DT, Td) sometimes also include protection against whooping cough or pertussis (i.e., DTaP, Tdap).

Who Should Get Diphtheria, Tetanus, and Whooping Cough Vaccines?

CDC recommends diphtheria, tetanus, and whooping cough (pertussis) vaccination for everyone.

Talk to your or your child’s doctor if you have questions about diphtheria, tetanus, and whooping cough vaccines.

Babies and Children

Babies need 3 shots of DTaP to build up high levels of protection against diphtheria, tetanus, and whooping cough. Then, young children need 2 booster shots to maintain that protection through early childhood. CDC recommends shots at the following ages:

  • 2 months
  • 4 months
  • 6 months
  • 15 through 18 months
  • 4 through 6 years

For children who should not get whooping cough vaccines, doctors can give DT instead of DTaP. For example, children who had a very bad reaction to DTaP can receive DT. However, children who get DT will not receive any protection against whooping cough.

Tdap vaccine for preteens and teens.

Tdap Vaccine for Preteen and Teens [1 page]
This fact sheet answers general questions about the booster shot for preteens and teens.

Preteens and Teens

Preteens should get one shot of Tdap between the ages of 11 and 12 years to boost their immunity. Teens who didn’t get Tdap as a preteen should get one shot the next time they visit their doctor.

Pregnant Women

Women should get Tdap during the early part of the 3rd trimester of every pregnancy. By doing so, she helps protect her baby from whooping cough in the first few months of life.  Find out more about the Tdap pregnancy recommendation.

Adults

All adults who have never received one should get a Tdap shot. This can be given at any time, regardless of when they last got Td. This should be followed by either a Td or Tdap shot every 10 years.

Who Should Not Get These Vaccines?

Because of age or health conditions, some people should not get certain vaccines or should wait before getting them. Read the guidelines below and ask your or your child’s doctor for more information.

DT or Td

Tell the person who is giving the shot if you or your child:

  • Has had an allergic reaction after a previous shot of any vaccine that protects against tetanus or diphtheria, or has any severe, life-threatening allergies
  • Has ever had Guillain-Barré syndrome (also called “GBS”)
  • Has had severe pain or swelling after a previous shot of any vaccine that protects against tetanus or diphtheria
  • Is not feeling well
    • Children with minor illnesses, such as a cold, may be vaccinated. Children who are moderately or severely ill should usually wait until they recover before getting the vaccine. Your child’s doctor can give you more information.
  • DT only: Is 7 years or older
    • Doctors should not give DT to anyone 7 years or older. Talk to your child’s doctor about how your child can catch-up on their immunization schedule.
  • Td only: Is younger than 7 years old
    • Doctors should not give Td to anyone younger than 7 years old.

DTaP or Tdap

Tell the person who is giving the shot if you or your child:

  • Has had an allergic reaction after a previous shot of any vaccine that protects against tetanus, diphtheria, or whooping cough, or has any severe, life-threatening allergies
  • Has had a coma, decreased level of consciousness, or prolonged seizures within 7 days after a previous shot of any whooping cough vaccine
  • Has seizures or another nervous system problem
  • Has ever had Guillain-Barré syndrome (also called “GBS”)
  • Has had severe pain or swelling after a previous shot of any vaccine that protects against tetanus or diphtheria
  • Is not feeling well
    • Children with minor illnesses, such as a cold, may be vaccinated. Children who are moderately or severely ill should usually wait until they recover before getting the vaccine. Your child’s doctor can give you more information.
  • DTaP only: Is 7 years or older
    • Doctors should not give DTaP to anyone 7 years or older. Talk to your child’s doctor about how your child can catch-up on their immunization schedule.
  • Tdap only: Is younger than 7 years old
    • Doctors should not give Tdap to anyone younger than 7 years old.

What Types of Diphtheria, Tetanus, and Whooping Cough Vaccines Are There?

A combination vaccine contains 2 or more vaccines in a single shot in order to decrease the number of shots given.

The Food and Drug Administration licensed 12 combination vaccines for use in the United States to help protect against diphtheria and tetanus. Nine of these vaccines also help protect against whooping cough. Some of the vaccines include protection against other diseases as well, including Haemophilus influenzae type b disease, hepatitis B, and polio.

  • DTand Td (TENIVAC® and TDVAX®) provide protection against diphtheria and tetanus.
  • DTaP (DAPTACEL®, Infanrix®, Kinrix®, Pediarix®, Pentacel®, Quadracel®, and Vaxelis) provides protection against diphtheria, tetanus, and whooping cough.
  • Tdap (Adacel® and Boostrix®) provides protection against tetanus, diphtheria, and whooping cough.

Upper-case letters in these abbreviations mean the vaccine has a full-strength amount of that part of the vaccine. The lower-case “d” and “p” in Td and Tdap means these vaccines use smaller amounts of diphtheria and whooping cough. The “a” in DTaP and Tdap stands for “acellular,” meaning that the whooping cough component contains only parts of the bacteria instead of the whole bacteria.

DT and Td Vaccines

  • DT Generic: Doctors give this vaccine in a 5-shot series to babies and children 6 weeks through 6 years old. Doctors only use this vaccine for children who should not get whooping cough vaccines.
  • TDVAX®: Doctors give this vaccine every 10 years as a booster shot to people 7 years or older. Doctors may also give it as part of a 3-shot series to people 7 years or older who have not previously gotten any tetanus and diphtheria vaccines. Doctors may also use this vaccine to complete the childhood vaccine series for tetanus and diphtheria in people 7 years or older.
  • TENIVAC®: Doctors give this vaccine every 10 years as a booster shot to people 7 years or older. Doctors may also give it as part of a 3-shot series to people 7 years or older who have not previously gotten any tetanus and diphtheria vaccines. Doctors may also use this vaccine to complete the childhood vaccine series for tetanus and diphtheria in people 7 years or older.

Tdap Vaccines

  • Adacel®: Doctors give a single shot to preteens and teens, as well as adults who need it. Doctors give a shot to women during each pregnancy. Doctors also give it as part of a 3-shot series to people 7 years or older who have not previously gotten any tetanus, diphtheria, and whooping cough vaccines. Doctors may also use this vaccine to complete the childhood vaccine series for tetanus, diphtheria, and whooping cough in people 7 years or older. Doctors may use this vaccine in place of a Td vaccine every 10 years as a booster shot to people 7 years or older.
  • Boostrix®: Doctors give a single shot to preteens and teens, as well as adults who need it. Doctors give a shot to women during each pregnancy. Doctors also give it as part of a 3-shot series to people 7 years or older who have not previously gotten any tetanus, diphtheria, and whooping cough vaccines. Doctors may also use this vaccine to complete the childhood vaccine series for tetanus, diphtheria, and whooping cough in people 7 years or older. Doctors may use this vaccine in place of a Td vaccine every 10 years as a booster shot to people 7 years or older.

DTaP Vaccines

  • DAPTACEL®: Doctors use this vaccine for all 5 shots in the DTaP vaccine series in babies and children 6 weeks through 6 years old.
  • Infanrix®: Doctors use this vaccine for all 5 shots in the DTaP vaccine series in babies and children 6 weeks through 6 years old.
  • Kinrix®: Doctors use this vaccine as the fifth shot in the DTaP vaccine series in children 4 through 6 years old. It also gives protection against polio.
  • Pediarix®: Doctors use this vaccine for the first 3 shots in the DTaP vaccine series in babies and children 6 weeks through 4 years old. It also gives protection against polio and hepatitis B.
  • Pentacel®: Doctors use this vaccine for the first 4 shots in the DTaP vaccine series in babies and children 6 weeks through 4 years old. It also gives protection against polio and invasive disease caused by Haemophilus influenzae type b.
  • Quadracel®: Doctors use this vaccine as the fifth shot in the DTaP vaccine series in children 4 through 6 years old. It also gives protection against polio.
  • Vaxelis: Doctors use this vaccine for the first 3 shots in the DTaP vaccine series in babies and children 6 weeks through less than 1 year old. It also gives protection against polio, hepatitis B, and invasive disease caused by Haemophilus influenzae type b.

How Well Do These Vaccines Work?

Summary

Vaccines that help protect against diphtheria, tetanus, and whooping cough work well, but differ in exactly how well they work against each disease. Protection from these vaccines decreases over time.

The vaccines protect:

  • Nearly everyone (97 in 100) against diphtheria for approximately 10 years.
  • Virtually everyone against tetanus for approximately 10 years.

In studies showing how well the whooping cough component works for children who get all five doses, DTaP fully protects:

  • Nearly all children (98 in 100) within the year following the last dose.
  • About 7 in 10 children five years after getting the last dose of DTaP. The other 3 in 10 kids are partially protected and are less likely to have serious disease if they do get whooping cough.

In studies showing how well the whooping cough component works, Tdap fully protects:

  • About 7 in 10 people in the first year after getting it.
  • About 3 or 4 in 10 people four years after getting it.

In studies showing how well the whooping cough component works when women get Tdap during pregnancy, the vaccine protects:

  • More than 3 in 4 babies younger than 2 months old from getting whooping cough.
  • About 9 in 10 babies from whooping cough infections serious enough to need treatment in a hospital.

In Depth

Diphtheria

Diphtheria was once a major cause of illness and death among children. The United States recorded 206,000 cases of diphtheria in 1921, resulting in 15,520 deaths. Starting in the 1920s, diphtheria rates dropped quickly in the United States and other countries that began widely vaccinating. Due to the success of the U.S. immunization program, diphtheria is now nearly unheard of in the United States. In 2019, countries reported more than 22,900 cases to the World Health Organization, but many more cases likely go unreported.

Tetanus

The United States introduced the first tetanus-toxoid containing vaccine into the routine childhood immunization schedule in the late 1940s. At that time, states reported between 500 and 600 cases each year. Tetanus infections steadily declined after the vaccination recommendation. Today, tetanus is uncommon in the United States, with an average of 30 reported cases each year. Nearly all cases of tetanus today are in people who never got a tetanus vaccine or did not receive a complete course of tetanus vaccines, or adults who didn’t stay up to date on their 10-year booster shots.

Whooping Cough

Helpful Terms
  • Acellular vaccine: A vaccine that is made using part of the bacterium or organism
  • Whole cell vaccine: A vaccine that is made using a weakened form of the entire bacterium or organism

Whooping cough vaccines became widely available in the 1940s. Before then, about 200,000 children got sick and about 9,000 died from whooping cough each year in the United States. After vaccine introduction, whooping cough cases reached an all-time low in the 1970s. Since then, there has been a slow but steady increase in reported whooping cough cases. There are several reasons likely contributing to this increase:

  • Increased awareness
  • Improved diagnostic tests
  • Better reporting
  • More spread (circulation) of the bacteria
  • Waning immunity (when a vaccine does not provide long-lasting protection) from current vaccines

The bacteria that cause whooping cough are also always changing at a genetic level. Research is underway to determine if any of the changes are having an impact on public health. However, the latest studies suggest that whooping cough vaccines continue to be effective despite recent genetic changes.

Learn more about whooping cough outbreaks.

What Are the Possible Side Effects?

Most people who get a vaccine that helps protect against diphtheria, tetanus, and whooping cough do not have any serious problems with it. With any medicine, including vaccines, there is a chance of side effects. These are usually mild and go away on their own within a few days, but serious reactions are possible.

Mild Problems

DT Vaccine

Mild problems following DT vaccination can include:

  • Reactions where the doctor gave the shot
    • Redness
    • Swelling
    • Soreness or tenderness
  • Fever
  • Loss of appetite
  • Vomiting

DTaP Vaccine

Mild problems following DTaP vaccination can include:

  • Reactions where the doctor gave the shot
    • Swelling
    • Soreness
  • Fever
  • Irritability (fussiness)
  • Feeling tired
  • Loss of appetite
  • Vomiting

More serious reactions, such as seizures, non-stop crying for 3 hours or more, or high fever (over 105°F) after DTaP vaccination happen much less often. Rarely, vaccination is followed by swelling of the entire arm or leg, especially in older children when they receive their fourth or fifth dose.

Td Vaccine

Problems following Td vaccination can include:

  • Reactions where the doctor gave the shot
    • Pain
    • Redness
    • Swelling
  • Mild fever
  • Headache
  • Feeling tired
  • Nausea, vomiting, diarrhea, or stomachache

Tdap Vaccine

Problems following Tdap vaccination can include:

  • Reactions where the doctor gave the shot
    • Pain
    • Redness
    • Swelling
  • Mild fever
  • Headache
  • Feeling tired
  • Nausea, vomiting, diarrhea, or stomachache

Problems that Could Happen after Getting Any Injected Vaccine

  • People sometimes faint after medical procedures, including vaccination. Sitting or lying down for about 15 minutes after receiving a vaccine can help prevent fainting and injuries caused by a fall. Tell your doctor if you or your child:
    • Feels dizzy
    • Has vision changes
    • Has ringing in the ears
  • As with any medicine, there is a very remote chance of a vaccine causing a severe allergic reaction, other serious injury, or death.

Where Can I Find These Vaccines?

Your or your child’s doctor’s office is usually the best place to receive recommended vaccines.

Finding vaccines for children

These vaccines are part of the routine childhood immunization schedule. Therefore, they are regularly available for children at:

  • Pediatric offices
  • Family practice offices
  • Community health clinics
  • Public health departments
  • Pharmacies

Finding vaccines for adults

If your doctor does not have these vaccines for adults, ask for a referral.

These vaccines may also be available for adults at:

  • Pharmacies
  • Workplaces
  • Community health clinics
  • Health departments
  • Other community locations such as schools and religious centers

You can also contact your state health department to learn more about where to get vaccines in your community.

Recording your vaccination

When receiving any vaccine, ask the doctor or vaccine provider to record the vaccine in the state or local registry, if available. This helps doctors at future encounters know what vaccines you or your child have already received.

How Can I Get Help Paying for These Vaccines?

There are several ways to cover the cost of diphtheria, tetanus, and whooping cough vaccines:

Medicare

Medicare Part D plans cover Tdap vaccine, but there may be costs to you depending on your specific plan.

Private Health Insurance

Most private health insurance plans cover these vaccines. Check with your insurance provider for details on whether there is any cost to you and for a list of in-network vaccine providers.

Vaccines for Children Program

Most health insurance plans cover routine vaccinations. The Vaccines for Children (VFC) program also provides vaccines for children 18 years and younger who are uninsured, underinsured, Medicaid-eligible, American Indian, or Alaska Native.

Related Pages
Page last reviewed: September 6, 2022