Tetanus Booster Vaccines
Either Td (tetanus-diphtheria) or Tdap (tetanus-diphtheria-acellular pertussis) vaccine can be used for tetanus boosters every 10 years throughout life. 1
Available Vaccine Products
Two Tdap vaccines are licensed in the United States:
- Boostrix (GlaxoSmithKline): Approved for persons aged ≥10 years 1
- Adacel (Sanofi Pasteur): Approved for persons aged 10-64 years 1
Both can now be used interchangeably with Td vaccine for booster doses, representing a significant update from previous guidelines that restricted repeat Tdap use.
Current ACIP Recommendations (2019 Update)
The Advisory Committee on Immunization Practices updated recommendations in October 2019 to allow either Td or Tdap in situations where previously only Td was recommended 1. This change increases provider flexibility at point-of-care.
Specific Booster Situations:
Decennial (10-year) boosters:
- Either Td or Tdap every 10 years throughout life for all persons aged ≥11 years 1
- This applies even if the person has previously received Tdap
Wound management:
- For persons who have NOT previously received Tdap: Tdap is preferred 1
- For persons who HAVE received Tdap: Either Td or Tdap may be used if >5 years have elapsed since last tetanus-containing vaccine 1
- For pregnant women requiring wound prophylaxis: Always use Tdap 1
Catch-up immunization:
- First dose should be Tdap, then either Td or Tdap for subsequent doses 1
Special Populations
Pregnant women:
- Tdap during EACH pregnancy at 27-36 weeks gestation (preferably earlier in this window), regardless of previous Tdap history 1
- This is off-label use but strongly recommended to protect newborns
Adults ≥65 years:
- Either Tdap or Td can be used 1
- Note: Only Boostrix is FDA-approved for this age group, but either vaccine is considered valid if administered 1
Key Clinical Pearls
The 2019 guideline change was driven by:
- Reassuring safety profile of repeated Tdap doses 1
- Evidence of widespread real-world use of Tdap in place of Td 1
- Need for provider flexibility 1
Important caveat: While ACIP allows either vaccine, Tdap costs more than Td, and there remains uncertainty about the population-level impact of multiple Tdap doses on pertussis control 1. However, the safety profile supports flexible use in clinical practice.
No minimum interval required: If Tdap is indicated (e.g., pregnancy, never received Tdap), it should not be delayed regardless of interval since last tetanus-containing vaccine 1