Diphtheria, Tetanus, and Pertussis Vaccines
About the Diseases
Diphtheria, tetanus, and pertussis are potentially serious bacterial diseases that can be safely prevented in adults and children with vaccines.
Diphtheria causes a thick membrane-like covering in the back of the throat. It can lead to breathing problems, paralysis, heart failure, and even death. Learn more about diphtheria.
Tetanus (also known as lockjaw) is a serious disease that causes painful tightening of the muscles, usually all over the body. It can lead to “locking” of the jaw so the person cannot open their mouth or swallow. Tetanus leads to death in about 1 in 10 cases. Learn more about tetanus.
Pertussis (also known as whooping cough) is a highly contagious respiratory tract infection. Although it initially resembles an ordinary cold, whooping cough may eventually turn more serious, particularly in infants. Learn more about pertussis.
Vaccines are available that can help prevent these diseases. CDC recommends:
- Children and preteens should get five doses of DTaP vaccine and a Tdap vaccine booster.
- Pregnant women should get one dose of Tdap vaccine every pregnancy, preferably early in the 3rd trimester.
- Adults should get one dose of Tdap or Td every 10 years. Adults who have never received Tdap should get it in place of a Td dose.
For more information, including catch-up schedules, see CDC’s recommended Child and Adult Immunization Schedules.
Available Vaccines and Package Inserts
There are several different types of vaccines that can safety prevent diphtheria, tetanus, and pertussis:
- DTaP (diphtheria, tetanus, and acellular pertussis) vaccine, which is given to children
- DT (diphtheria and tetanus) vaccine, which is given to children
- Tdap (combined tetanus, diphtheria and acellular pertussis) vaccine, which is given to adolescents and adults
- Td (tetanus and diphtheria) vaccine, which is given to adolescents and adults
Manufacturer Package Inserts
Daptacel [PDF – 26 pages]external icon
The Food and Drug Administration (FDA) approved this vaccine in 2002. It is approved for use in children who are 6 weeks through 6 years of age to protect against diphtheria, tetanus, and pertussis.
Infanrix [PDF – 19 pages]external icon
FDA approved this vaccine in 1997. It is approved for use in children who are 6 weeks through 6 years of age to protect against diphtheria, tetanus, and pertussis.
Kinrix [PDF – 15 pages]external icon
FDA approved this vaccine in 2008. It is approved for use in children who are 4 to 6 years of age to protect against diphtheria, tetanus, pertussis, and polio.
Pediarix [PDF – 24 pages]external icon
FDA approved this vaccine in 2002. It is approved for use in children who are 6 weeks through 6 years of age to protect against diphtheria, tetanus, pertussis, polio, and hepatitis B.
Pentacel [PDF – 37 pages]external icon
FDA approved this vaccine in 2008. It is approved for use in children who are 6 weeks through 4 years of age to protect against diphtheria, tetanus, pertussis, Haemophilus Influenzae type B (Hib), and polio.
Quadracel [PDF – 15 pages]external icon
FDA approved this vaccine in 2015. It is approved for use in children who are 4 through 6 years of age to protect against diphtheria, tetanus, pertussis, and polio
Generic diphtheria and tetanus vaccine [PDF – 13 pages]external icon
There is a generic vaccine to protect against diphtheria and tetanus in children up to 7 years for whom the pertussis vaccine component is contraindicated or in situations where the health care provider decides the pertussis vaccine should not be administered. The concentration of diphtheria toxoid is higher in DT vaccine compared to Td vaccine. It was first approved in 1997.
Boostrix [PDF – 26 pages]external icon
FDA approved this vaccine in 2005. It is approved for use in people 10 years of age and older to protect against diphtheria, tetanus, and pertussis.
Adacel [PDF – 29 pages]external icon
FDA approved this vaccine in 2005. It is approved for use in people 10 through 64 years of age to protect against diphtheria, tetanus, and pertussis.
Generic tetanus and diphtheria vaccine [PDF – 7 pages]external icon
There is a generic vaccine to protect against tetanus and diphtheria and in people 7 years of age and older. It was approved by FDA in 1967.
Common Side Effects
DTaP, DT, Td, and Tdap vaccines are safe and effective at preventing diphtheria and tetanus. DTaP and Tdap vaccine are safe and effective at preventing diphtheria, tetanus, and pertussis. Vaccines, like any medicine, can have side effects. The most common side effects are usually mild and go away on their own.
Severe allergic reactions following vaccination are rare, but can be life threatening.
Symptoms of a severe allergic reaction can include hives, swelling of the face and throat, difficulty breathing, a fast heartbeat, dizziness, and weakness.
If such reactions occur, call 9-1-1 and get the person to the nearest hospital.
- Soreness or swelling where the shot was given
- Feeling tired
- Loss of appetite
Most side effects are mild to moderate and can last from 1 to 3 days.
Who Should Not Get DTaP Vaccine
DTaP is not for children 7 years of age and older.
Parents should talk to their child’s doctor about receiving the DTaP vaccine if their child:
- had a severe allergic reaction after previous dose of DTaP,
- was in a coma or had long repeated seizures within 7 days after a dose of DTaP,
- developed a condition called Guillain-Barré Syndrome (GBS) within 6 weeks of a DTaP dose or
- had severe pain or swelling after a previous dose of DTaP or DT vaccine.
In some cases, the physician may decide to postpone the child’s DTaP vaccination to a future visit.
Children who are moderately or severely ill should usually wait until they recover before getting the DTaP vaccine.
- Pain, redness, or swelling where the shot was given
- Mild fever
- Feeling tired
- Nausea, vomiting, diarrhea, stomach ache
Who Should Not Get Tdap Vaccine
A person who has ever had a life-threatening allergic reaction after a previous dose of diphtheria, tetanus or pertussis containing vaccine, or has a severe allergy to any part of this vaccine, should not get Tdap vaccine.
Anyone who has been in a coma or had long, repeated seizures within 7 days after a childhood dose of DTaP, should not get Tdap, unless a cause other than the vaccine was found. They can still get Td.
A person should have a discussion with their doctor about getting the Tdap vaccine if they:
- had seizures or another nervous system problem,
- had severe pain or swelling after any vaccine containing diphtheria, tetanus, or pertussis,
- developed a condition called Guillain-Barré Syndrome (GBS) within 6 weeks of a Tdap dose, or
- aren’t feeling well on the day the shot is scheduled.
- Loss of appetite, nausea
- Pain where shot was given
Who Should Not Get DT Vaccine
DT is not for children 7 years of age and older.
Parents should talk to their children’s doctor about receiving the DT vaccine if their child:
- has a history of seizures,
- received chemotherapy or radiation,
- developed a condition called Guillain-Barré Syndrome (GBS) within 6 weeks of a DT dose , or
- had severe pain or swelling after previous dose of DT or DTaP vaccine.
In some cases, the physician may decide to postpone the child’s DT vaccination to a future visit.
- Pain, redness, or swelling where the shot was given
Who Should Not Get Td Vaccine
A person who has ever had a severe allergic reaction after a previous dose of any tetanus or diphtheria containing vaccine should not get a Td vaccine.
A person should have a discussion with their doctor about getting the Td vaccine if they:
- had severe pain or swelling after any vaccine containing diphtheria or tetanus,
- developed a condition called Guillain-Barré Syndrome (GBS) within 6 weeks of a Td dose , or
- aren’t feeling well on the day the shot is scheduled.
DTaP (younger children)
- DTaP safety reviews of VAERS reports found no unexpected health concerns related to the vaccine.
- Several studies of DTaP vaccine safety have looked for neurologic problems or seizures after children were vaccinated, and found that there is no increased risk for these concerns with the DTaP vaccine
- There is a small increased risk for febrile seizures when inactivated influenza vaccine (flu shot) is given during the same doctor’s visit as either the PCV13 (pneumococcal) vaccine or the DTaP vaccine.
- DTaP may cause mild injection site reactions. However, severe injection site reactions are rare, and may be less frequent when the vaccine is injected into the leg rather than into the arm. Reactions happen about as often when DTaP is combined with other vaccines.
Tdap (adolescents and adults)
- Tdap safety reviews of VAERS reports have found no unexpected safety concerns for the general population, for pregnant women, or for adults over age 65.
- In the VSD, studies have found no association between Tdap vaccination and Guillain-Barré Syndrome or other neurologic disorders. Other studies have found that there is no increased risk for other types of health problems, such as allergies, blood disorders, and chronic illnesses.
- Although injection site reactions are common, studies have found a low rate of severe injection site reactions. These local reactions are unusual even when the vaccine is given at the same time as meningococcal vaccine (Menactra), or when a person receives several doses of Tdap vaccine over a short time period.
Seizures caused by fever are called “febrile seizures.” When they occur in young children, these seizures are frightening for parents. However, most children recover from them quickly and have no long lasting effects. Learn more about febrile seizures.
Which adverse events are considered “serious”?
By the Code of Federal Regulations (CFR) Title 21external icon, an adverse event is defined as serious if it involves any of the following outcomes
- A life-threatening adverse event
- A persistent or significant disability or incapacity
- A congenital anomaly or birth defect
- Hospitalization, or prolongation of existing hospitalization
Learn more about adverse events.
How CDC Monitors Vaccine Safety
CDC and FDA monitor the safety of vaccines after they are approved. If a problem is found with a vaccine, CDC and FDA will inform health officials, health care providers, and the public.
CDC uses 3 systems to monitor vaccine safety:
- The Vaccine Adverse Event Reporting System (VAERS): an early warning system, co-managed by CDC and FDA, to monitor for potential vaccine safety problems. Anyone can report possible vaccine side effects to VAERS.
- The Vaccine Safety Datalink (VSD): a collaboration between CDC and 9 health care organizations that conducts vaccine safety monitoring and research.
- The Clinical Immunization Safety Assessment (CISA) Project: a partnership between CDC and several medical research centers that provides expert consultation and conducts clinical research on vaccine-associated health risks.
Related Scientific Articles
Moro PL, Perez-Vilar S, Lewis P, Bryant-Genevier M, Kamiya H, Cano M. Safety Surveillance of Diphtheria and Tetanus Toxoids and Acellular Pertussis (DTaP) Vaccinesexternal icon. Pediatrics. 2018 Jul; 142(1). pii: e20174171. Epub 2018 Jun 4.
Liang JL, Tiwari T, Moro P, et al. Prevention of Pertussis, Tetanus, and Diphtheria with Vaccines in the United States: Recommendations of the Advisory Committee on Immunization Practices (ACIPexternal icon). MMWR Recomm Rep 2018 April; 67(No. RR-2): 1–44.
Duffy J, Weintraub E, Hambidge S, Jackson L, Kharbanda E, Klein N, et al. Febrile Seizure Risk Following Vaccination in children 6-23 monthsexternal icon. Pediatrics. 2016 Jul; 138(1). Epub 2016 Jun 6,
Kawai AT, Martin D, Kulldorff M, Li L, Cole DV, McMahill-Walraven CN, Selvam N, Selvan MS, Lee GM. Febrile Seizures After 2010-2011 Trivalent Inactivated Influenza Vaccineexternal icon. Pediatrics. 2015 Oct; 136(4): e848-55. Epub 2015 Dep 14.
Daley MF, Yih WK, Glanz JM, Hambidge SJ, Narwaney KJ, Yin R, Li L, Nelson JC, Nordin JD, Klein NP, Jacobsen SJ, Weintraub E. Safety of diphtheria, tetanus, acellular pertussis and inactivated poliovirus (DTaP-IPV) vaccineexternal icon. Vaccine. 2014 May 23; 32(25): 3019-24. Epub 2014 Mar 31.
Jackson LA, Peterson D, Nelson JC, Marcy SM, Naleway AL, Nordin JD, Donahue JG, Hambidge SJ, Balsbaugh C, Baxter R, Marsh T, Madziwa L, Weintraub E. Vaccination site and risk of local reactions in children 1 through 6 years of ageexternal icon. Pediatrics. 2013 Feb; 131(2): 283-9. Epub 2013 Jan 14.
Nelson JC, Yu O, Dominguez-Islas CP, Cook AJ, Peterson D, Greene SK, Yih WK, Daley MF, Jacobsen SJ, Klein NP, Weintraub ES, Broder KR, Jackson LA. Adapting group sequential methods to observational postlicensure vaccine safety surveillance: results of a pentavalent combination DTaP-IPV-Hib vaccine safety studyexternal icon. Am J Epidemiol. 2013 Jan 15; 177(2): 131-41. Epub 2013 Jan 4.
Sun Y, Christensen J, Hviid A, Li J, Vedsted P, Olsen J, Vestergaard M. Risk of febrile seizures and epilepsy after vaccination with diphtheria, tetanus, acellular pertussis, inactivated poliovirus, and Haemophilus influenzae type Bexternal icon. JAMA. 2012 Feb 22; 307(8): 823-31.
Jackson LA, Yu O, Nelson JC, Dominguez C, Peterson D, Baxter R, Hambidge SJ, Naleway AL, Belongia EA, Nordin JD, Baggs J; Vaccine Safety Datalink Team. Injection site and risk of medically attended local reactions to acellular pertussis vaccineexternal icon. Pediatrics. 2011 Mar; 127(3): e581-7. Epub 2011 Feb 7.
Andrews N, Stowe J, Wise L, Miller E. Post-licensure comparison of the safety profile of diphtheria/tetanus/whole cell pertussis/haemophilus influenza type b vaccine and a 5-in-1 diphtheria/tetanus/acellular pertussis/haemophilus influenza type b/polio vaccine in the United Kingdomexternal icon. Vaccine. 2010 Oct 18; 28(44): 7215-20. Epub 2010 Aug 26.
Huang WT, Gargiullo PM, Broder KR, Weintraub ES, Iskander JK, Klein NP, Baggs JM; Vaccine Safety Datalink Team. Lack of association between acellular pertussis vaccine and seizures in early childhood.external icon Pediatrics. 2010 Aug; 126(2): 263-9. Epub 2010 Jul 19.
Zangwill KM, Eriksen E, Lee M, Lee J, Marcy SM, Friedland LR, Weston W, Howe B, Ward JI. A population-based, postlicensure evaluation of the safety of a combination diphtheria, tetanus, acellular pertussis, hepatitis B, and inactivated poliovirus vaccine in a large managed care organizationexternal icon. Pediatrics. 2008 Dec; 122(6): e1179-85.
Moore DL, Le Saux N, Scheifele D, Halperin SA; Members of the Canadian Paediatric Society/Health Canada Immunization Monitoring Program Active (IMPACT).Lack of evidence of encephalopathy related to pertussis vaccine: active surveillance by IMPACT, Canada, 1993-2002external icon. Pediatr Infect Dis J. 2004 Jun; 23(6): 568-71.
Jackson LA, Carste BA, Malais D, Froeschle J. Retrospective population-based assessment of medically attended injection site reactions, seizures, allergic responses and febrile episodes after acellular pertussis vaccine combined with diphtheria and tetanus toxoidsexternal icon. Pediatr Infect Dis J. 2002 Aug; 21(8): 781-6.
DeSilva M, Vazquez-Benitez G, Nordin JD, Lipkind HS, Romitti PA, DeStefano F, Kharbanda EO. Tdap Vaccination During Pregnancy and Microcephaly and Other Structural Birth Defects in Offspring. external icon JAMA. 2016 Nov 1; 316(17): 1823-1825.
Berenson AB, Hirth JM, Rahman M, Laz TH, Rupp RE, Sarpong KO. Maternal and infant outcomes among women vaccinated against pertussis during pregnancyexternal icon. Hum Vaccin Immunother. 2016 Aug 2; 12(8): 1965-1971. Epub 2016 Mar 22.
Petousis-Harris H, Walls T, Watson D, Paynter J, Graham P, Turner N. Safety of Tdap vaccine in pregnant women: an observational study.external icon BMJ Open. 2016 Apr 18; 6(4): e010911.
Moro PL, Cragan J, Tepper N, Zheteyeva Y, Museru O, Lewis P, Broder K. Enhanced surveillance of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccines in pregnancy in the Vaccine Adverse Event Reporting System (VAERS), 2011-2015external icon. Vaccine. 2016 Apr 29; 34(20): 2349-53. Epub 2016 Mar 22.
Regan AK, Tracey LE, Blyth CC, Richmond PC, Effler PV. A prospective cohort study assessing the reactogenicity of pertussis and influenza vaccines administered during pregnancy. external icon Vaccine. 2016 Apr 29; 34(20): 2299-304. Epub 2016 Mar 31.
Kharbanda EO, Vazquez-Benitez G, Lipkind HS, Klein NP, Cheetham TC, Naleway AL, Lee GM, Hambidge S, Jackson ML, Omer SB, McCarthy N, Nordin JD. Maternal Tdap vaccination: Coverage and acute safety outcomes in the vaccine safety datalink, 2007-2013.external icon Vaccine. 2016 Feb 10; 34(7): 968-73. Epub 2016 Jan 4.
Walls T, Graham P, Petousis-Harris H, Hill L, Austin N. Infant outcomes after exposure to Tdap vaccine in pregnancy: an observational studyexternal icon. BMJ Open. 2016 Jan 6; 6(1): e009536.
Sukumaran L, McCarthy NL, Kharbanda EO, Weintraub ES, Vazquez-Benitez G, McNeil MM, Li R, Klein NP, Hambidge SJ, Naleway AL, Lugg MM, Jackson ML, King JP, DeStefano F, Omer SB, Orenstein WA. Safety of Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis and Influenza Vaccinations in Pregnancyexternal icon. Obstet Gynecol. 2015 Nov; 126(5): 1069-74.
Sukumaran L, McCarthy NL, Kharbanda EO, McNeil MM, Naleway AL, Klein NP, Jackson ML, Hambidge SJ, Lugg MM, Li R, Weintraub ES, Bednarczyk RA, King JP, DeStefano F, Orenstein WA, Omer SB. Association of Tdap Vaccination With Acute Events and Adverse Birth Outcomes Among Pregnant Women With Prior Tetanus-Containing Immunizationsexternal icon. JAMA. 2015 Oct 20; 314(15): 1581-7.
Morgan JL, Baggari SR, McIntire DD, Sheffield JS. Pregnancy outcomes after antepartum tetanus, diphtheria, and acellular pertussis vaccinationexternal icon. Obstet Gynecol. 2015 Jun; 125(6): 1433-8.
Kharbanda EO, Vazquez-Benitez G, Lipkind HS, Klein NP, Cheetham TC, Naleway A, Omer SB, Hambidge SJ, Lee GM, Jackson ML, McCarthy NL, DeStefano F, Nordin JD. Evaluation of the association of maternal pertussis vaccination with obstetric events and birth outcomesexternal icon. JAMA. 2014 Nov 12; 312(18): 1897-904.
Donegan K, King B, Bryan P. Safety of pertussis vaccination in pregnant women in UK: observational studyexternal icon. BMJ. 2014 Jul 11; 349: g4219.
Shakib JH, Korgenski K, Sheng X, Varner MW, Pavia AT, Byington CL. Tetanus, diphtheria, acellular pertussis vaccine during pregnancy: pregnancy and infant health outcomesexternal icon. J Pediatr. 2013 Nov; 163(5): 1422-6.e1-4. Epub 2013 Jul 26.
Chang S, O’Connor PM, Slade BA, Woo EJ. U.S. Postlicensure safety surveillance for adolescent and adult tetanus, diphtheria and acellular pertussis vaccines: 2005-2007external icon. Vaccine. 2013 Feb 27; 31(10): 1447-52. Epub 2012 Nov 8.
Zheteyeva YA, Moro PL, Tepper NK, Rasmussen SA, Barash FE, Revzina NV, Kissin D, Lewis PW, Yue X, Haber P, Tokars JI, Vellozzi C, Broder KR. Adverse event reports after tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccines in pregnant womenexternal icon. Am J Obstet Gynecol. 2012 Jul; 207(1): 59.e1-7. Epub 2012 May 14.
Moro PL, Yue X, Lewis P, Haber P, Broder K. Adverse events after tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap) vaccine administered to adults 65 years of age and older reported to the Vaccine Adverse Event Reporting System (VAERS), 2005-2010.external icon Vaccine. 2011 Nov 21; 29(50): 9404-8. Epub 2011 Sep 13.
Nordin JD, Yih WK, Kulldorff M, Weintraub E. Tdap and GBS (letter)external icon. Vaccine. 2011 Feb 1; 29(6): 1122.
Talbot EA, Brown KH, Kirkland KB, Baughman AL, Halperin SA, et al. The safety of immunizing with tetanus-diphtheria-acellular pertussis vaccine (Tdap) less than 2 years following previous tetanus vaccination: Experience during a mass vaccination campaign of healthcare personnel during a respiratory illness outbreak.external icon Vaccine. 2010 Nov; 28(50): 8001-7. Epub 2010 Sep 25.
Klein NP, Hansen J, Lewis E, Lyon L, Nguyen B, et al. Post-marketing safety evaluation of a tetanus toxoid, reduced diphtheria toxoid and 3-component acellular pertussis vaccine administered to a cohort of adolescents in a United States health maintenance organization.external icon Pediatr Infect Dis J. 2010 Jul; 29(7): 613-7.
Jackson LA, Yu O, Nelson J, Belongia EA, Hambidge SJ, et al. Risk of medically attended local reactions following diphtheria toxoid containing vaccines in adolescents and young adults: A Vaccine Safety Datalink study.external icon Vaccine. 2009 Aug 6; 27(36): 4912-6. Epub 2009 Jun 28.
Yih WK, Nordin JD, Kulldorff M, Lewis E, Lieu TA, et al. An assessment of the safety of adolescent and adult tetanus-diphtheria-acellular pertussis (Tdap) vaccine, using active surveillance for adverse events in the Vaccine Safety Datalink.external icon Vaccine. 2009 Jul 9; 27(32):4257-62. Epub 2009 May 30.
Halperin SA, Sweet L, Baxendale D, Neatby A, Rykers P, et al. How soon after a prior tetanus-diphtheria vaccination can one give adult formulation tetanus-diphtheria-acellular pertussis vaccine?external icon Pediatr Infect Dis J. 2006; 25(3): 195-200.