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Diphtheria, Tetanus, and Whooping Cough Vaccination: What Everyone Should Know

One of the Recommended Vaccines

Key Facts

Vaccines used today against diphtheria and tetanus (i.e., DT and Td) sometimes also include protection against whooping cough or pertussis (i.e., DTaP and Tdap). Babies and children younger than 7 years old receive DTaP or DT, while older children and adults receive Tdap and Td.

 

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

CDC recommends diphtheria, tetanus, and whooping cough (pertussis) vaccination for everyone. Vaccines used today against diphtheria and tetanus (i.e., DT and Td) sometimes also include protection against whooping cough (i.e., DTaP and Tdap). Babies and children younger than 7 years old receive DTaP or DT, while older children and adults receive Tdap and Td.

Talk to your or your child’s healthcare professional about what is best for your specific situation.

Babies and Children

Babies need three doses of DTaP to build up high levels of protection against diphtheria, tetanus, and whooping cough. Then, young children need two booster shots to maintain that protection through early childhood. CDC recommends doses 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, healthcare professionals can give DT instead of DTaP. For example, children who had a very bad reaction to DTaP can receive DT.

Preteens and Teens

Preteens should get one dose 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 dose the next time they visit their healthcare professional.

Pregnant Women

Pregnant women should get Tdap during 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

Adults should get one dose of Td every 10 years. Adults who have never received Tdap should get it in place of a Td dose. Healthcare professionals can give Tdap to these adults at any time, regardless of when they last got Td.

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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 healthcare professional for more information.

DT

Tell the person who is giving your child DT if:

Your child has had a life-threatening allergic reaction or has a severe allergy.

  • Any child who had a life-threatening allergic reaction after a dose of DT should not get another dose.
  • Any child with a severe allergy to any component of DT should not get this vaccine. Your child’s healthcare professional can tell you about the vaccine’s ingredients.

A healthcare professional has diagnosed your child with specific illnesses or conditions.

  • Talk with your child’s healthcare professional if your child:
    • Has seizures or another nervous system problem.
    • Had severe pain or swelling after any vaccine containing tetanus or diphtheria.
    • Ever had a condition called Guillian-Barré Syndrome.

Your child is not feeling well.

  • If your child has a mild illness, such as a cold, they can probably get the vaccine. If your child has a more serious illness, they should probably wait until they recover. Your child’s healthcare professional can advise you.

Your child is 7 years or older.

  • Healthcare professionals should not give DT to anyone 7 years or older. Talk to your child’s healthcare professional about how your child can catch-up on their immunization schedule.

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DTaP

Tell the person who is giving your child DTaP if:

Your child has had a life-threatening allergic reaction.

  • Any child who had a life-threatening allergic reaction after a dose of DTaP should not get another dose.

A healthcare professional has diagnosed your child with specific illnesses or conditions.

  • Any child who suffered a brain or nervous system disease within 7 days after a dose of DTaP not attributable to another cause should not get another dose.
  • Talk with the healthcare professional if your child:
    • Had severe pain or swelling after any vaccine containing tetanus or diphtheria.
    • Ever had a condition called Guillian-Barré Syndrome.
  • Some of the following children should not get another dose of DTaP, but may get DT. Talk with your child’s healthcare professional if your child:
    • Had a seizure or collapsed after a dose of DTaP.
    • Cried non-stop for three hours or more after a dose of DTaP.
    • Had a fever over 105°F after a dose of DTaP.

Your child is not feeling well.

  • If your child has a mild illness, such as a cold, they can probably get the vaccine. If your child has a more serious illness, they should probably wait until they recover. Your child’s healthcare professional can advise you.

Your child is 7 years or older.

  • Healthcare professionals should not give DTaP to anyone 7 years or older. Talk to your child’s healthcare professional about how your child can catch-up on their immunization schedule.

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Td

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

You or your child have had a life-threatening allergic reaction or have a severe allergy.

  • Anyone who has had a life-threatening allergic reaction to a dose of this vaccine or to any tetanus- or diphtheria toxoid-containing vaccine should not get this vaccine.
  • Anyone with a severe allergy to any component of Td should not get this vaccine. Your or your child’s healthcare professional can tell you about the vaccine’s ingredients.

You or your child have had a previous reaction to similar vaccines or a healthcare professional has diagnosed you or your child with specific illnesses or conditions.

  • Talk with the healthcare professional if you or your child:
    • Had severe pain or swelling after any vaccine containing tetanus or diphtheria.
    • Ever had a condition called Guillian-Barré Syndrome.

You or your child are not feeling well.

  • People who have a mild illness, such as a cold, can probably get the vaccine. People who have a more serious illness should probably wait until they recover. Your or your child’s healthcare professional can advise you.

Your child is younger than 7 years old.

  • Healthcare professionals should not give Td to anyone younger than 7 years old.

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Tdap

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

You or your child have had a life-threatening allergic reaction or have a severe allergy.

  • Anyone who has had a life-threatening allergic reaction to a dose of this vaccine or to any diphtheria toxoid-, tetanus toxoid-, or whooping cough-containing vaccine should not get this vaccine.
  • Anyone with a severe allergy to any component of Tdap should not get this vaccine. Your or your child’s healthcare professional can tell you about the vaccine’s ingredients.

You or your child have had a previous reaction to similar vaccines.

  • Anyone who had coma or long repeated seizures within seven days after a childhood dose of DTP or DTaP, or a previous dose of Tdap, should not get Tdap, unless a cause other than the vaccine was found. They can still get Td.
  • Talk with your or your child’s healthcare professional if you:
    • Have seizures or another nervous system problem.
    • Had severe pain or swelling after any vaccine containing tetanus, diphtheria, or whooping cough.
    • Ever had a condition called Guillian-Barré Syndrome.

You or your child are not feeling well.

  • People who have a mild illness, such as a cold, can probably get the vaccine. People who have a more serious illness should probably wait until they recover. Your or your child’s healthcare professional can advise you.

Your child is younger than 7 years old.

  • Healthcare professionals should not give Tdap to anyone younger than 7 years old.

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

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

The Food and Drug Administration licensed 11 combination vaccines for use in the United States to help protect against diphtheria and tetanus. Eight of these vaccines also help protect against whooping cough. Some of the vaccines include protection against other diseases as well, including polio, Haemophilus influenzae type b disease, and hepatitis B.

  • DT (generic) and Td (Tenivac® and generic) provide protection against diphtheria and tetanus.
  • DTaP (Daptacel®, Infanrix®, Kinrix®, Pediarix®, Pentacel®, and Quadracel®) 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 full-strength doses of that part of the vaccine. The lower-case “d” and “p” in Td and Tdap means these vaccines use smaller doses 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 cell.

DT and Td Vaccines

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

 

DTaP Vaccines

  • Daptacel®: Doctors give five doses to babies and children 6 weeks through 6 years old.
  • Infanrix®: Doctors give five doses to babies and children 6 weeks through 6 years old.
  • Kinrix®: Doctors use this vaccine as the fifth dose in the DTaP vaccine series in children 4 through 6 years old. Doctors use it for children who received Infanrix® or Pediarix® for the first three doses and Infanrix® for the fourth dose. It also gives protection against poliomyelitis.
  • Pediarix®: Doctors give three doses to babies and children 6 weeks through 4 years old. It also gives protection against poliomyelitis and hepatitis B.
  • Pentacel®: Doctors give four doses to babies and children 6 weeks through 4 years old. It also gives protection against poliomyelitis and invasive disease caused by Haemophilus influenzae type b.
  • Quadracel®: Doctors use this vaccine as the fifth dose in the DTaP vaccine series in children 4 through 6 years old. Doctors use it for children who received four doses of Pentacel® or Daptacel®. It also gives protection against poliomyelitis.

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How Well Do These Vaccines Work?

Summary

Vaccines that help protect against diphtheria, tetanus, and whooping cough differ in how well they work against each disease.

The diphtheria and tetanus toxoid components of these vaccines work well for people who receive the primary series. (The primary series is three doses for people 7 years or older and four doses for children younger than 7.) The vaccines protect:

  • Nearly everyone (95 in 100) against diphtheria for approximately 10 years.
  • Almost 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.

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.

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In Depth

In general, diphtheria, tetanus, and whooping cough vaccines work well, but cannot prevent all cases of these serious diseases. Below is information about how well each of the vaccines work against each disease.

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. Since 2014, two cases of diphtheria in the Unites States were reported to CDC. However, the disease continues to play a role globally. In 2016, countries reported about 7,100 cases to the World Health Organization, but many more cases likely go unreported.

Studies estimate that diphtheria toxoid-containing vaccines protect nearly all people (95 in 100) for approximately 10 years. Protection decreases over time, so adults need to get a Td booster shot every 10 years to stay protected.

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.

Studies estimate that tetanus toxoid-containing vaccines protect essentially all people for approximately 10 years. Protection decreases over time, so adults need to get a Td booster shot every 10 years to stay protected.

Whooping Cough

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 1980s. Since then, there has been an increase in reported whooping cough cases. There are several reasons that help explain why we are seeing 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

CDC is looking into whether changes in the genetic makeup of the bacteria that cause whooping cough may also be part of the reason why more cases are being reported.

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

Compared to the vaccine the United States used in the past (known as DTP), DTaP does not protect against whooping cough for as long. In the 1990s, the United States switched from whole cell to acellular whooping cough vaccines for babies and children. Acellular whooping cough vaccines have fewer side effects, but do not provide long-lasting protection.

In general, DTaP is effective for 8 or 9 in 10 children who get it. Among children who get all five doses of DTaP on schedule, effectiveness is very high. The vaccine protects nearly all children (98 in 100) within the year following the last dose. Five years after getting the last DTaP dose, the vaccine fully protects about 7 in 10 children. The vaccine protects the other 3 children against serious disease.

In the first year after getting the vaccine, Tdap protects about 7 in 10 people. There is a decrease in effectiveness in each following year. The vaccine fully protects about 3 or 4 in 10 people four years after getting Tdap.

A CDC evaluation found Tdap vaccination during the third trimester of pregnancy prevents more than 3 in 4 cases of whooping cough in babies younger than 2 months old. For babies who do get whooping cough, the infection is typically less serious if their mother received Tdap during pregnancy. A CDC evaluation found getting Tdap during the third trimester of pregnancy protected 9 in 10 babies from infections serious enough to need treatment in a hospital.

Learn more about DTaP waning immunity and whooping cough outbreaks.

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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 healthcare professional 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 healthcare professional gave the shot
    • Redness
    • Swelling
    • Soreness or tenderness
  • Fever
  • Fussiness (irritability)
  • Feeling tired
  • Loss of appetite
  • Vomiting

Reactions where the healthcare professional gave the shot and fever occur more often after the fourth and fifth doses of the DTaP series than after earlier doses. Sometimes the entire arm or leg that the shot was given in swells after the fourth or fifth dose. If this happens, the swelling lasts between 1 and 7 days.

Td Vaccine

Mild problems following Td vaccination can include:

  • Reactions where the healthcare professional gave the shot
    • Pain
    • Redness
    • Swelling
  • Fever
  • Headache
  • Feeling tired

Tdap Vaccine

Mild problems following Tdap vaccination can include:

  • Reactions where the healthcare professional gave the shot
    • Pain
    • Redness
    • Swelling
  • Fever
  • Headache
  • Feeling tired
  • Nausea, vomiting, diarrhea, or stomach ache
  • Chills
  • Body aches or sore joints
  • Rash, swollen glands

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Problems that Could Happen after Getting Any Injected Vaccine

  • People sometimes faint after a medical procedure, 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 healthcare professional if you or your child:
    • Feels dizzy
    • Has vision changes
    • Has ringing in the ears
  • Some people get severe pain in the shoulder and have difficulty moving the arm where the healthcare professional gave the shot. This happens very rarely.
  • Any medicine can cause severe allergic reactions. Such reactions from a vaccine are very rare, estimated at about 1 in a million doses. These types of reactions would happen within a few minutes to a few hours after the vaccination.
  • As with any medicine, there is a very remote chance of a vaccine causing a serious injury or death.

For more information on possible side effects from vaccination, visit CDC’s Possible Side-effects from Vaccines webpage.

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Where Can I Find These Vaccines?

Where to Find Diphtheria, Tetanus, and Whooping Cough Vaccines

Your healthcare professional’s office is usually the best place to receive recommended vaccines for you or your child.

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

If your healthcare professional 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

Federally funded health centers can also provide services if you don’t have a regular source of health care. Locate one near you. You can also contact your state health department to learn more about where to get vaccines in your community.

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

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How Do I Pay 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

The Vaccines for Children (VFC) Program provides vaccines to children whose parents or guardians may not be able to afford them. A child is eligible if they are younger than 19 years old and meets one of the following requirements:

  • Medicaid-eligible
  • Uninsured
  • American Indian or Alaska Native
  • Underinsured (have health insurance that does not cover vaccines or does not cover certain vaccines)

If your child is VFC-eligible, ask if your healthcare professional is a VFC provider. For help in finding a VFC provider near you, contact your state or local health department’s VFC Program Coordinator or call CDC at 1-800-CDC-INFO (232-4636).

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References

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