What are the contraindications to the Tdap (Tetanus, diphtheria, and pertussis) vaccine?

Contraindications to Tdap Vaccine

Tdap (tetanus, diphtheria, and pertussis) vaccine is absolutely contraindicated in individuals with a history of serious allergic reaction (anaphylaxis) to any component of the vaccine or a history of encephalopathy within 7 days of a previous pertussis-containing vaccine not attributable to another cause. 1

Absolute Contraindications

1. Severe allergic reaction (anaphylaxis)

   • History of anaphylaxis to any component of Tdap vaccine 1, 2
   • Note: Patients with history of anaphylaxis to components in all Tdap/Td vaccines should be referred to an allergist to determine if they have specific allergy to tetanus toxoid and whether they can be desensitized 1

2. History of encephalopathy

   • Encephalopathy (e.g., coma or prolonged seizures) not attributable to an identifiable cause within 7 days of administration of a previous pertussis-containing vaccine 1
   • These individuals should receive Td instead of Tdap to ensure protection against tetanus and diphtheria 1

Precautions (Require Clinical Assessment)

Precautions represent conditions that may increase the risk for serious adverse reactions. In these situations, healthcare providers should evaluate the risks and benefits of administering Tdap:

1. Neurological conditions

   • Guillain-Barré syndrome occurring within 6 weeks after a previous dose of tetanus toxoid-containing vaccine 1
   • Progressive neurologic disorder, uncontrolled epilepsy, or progressive encephalopathy until the condition has stabilized 1

2. Previous severe reactions

   • History of Arthus reaction (severe local inflammation) following a previous dose of tetanus or diphtheria toxoid-containing vaccine 1
   • Consider deferring vaccination until at least 10 years have elapsed since the last tetanus/diphtheria toxoid-containing vaccine 1
   • Note: Arthus reactions are extremely rare (0.1 per million doses) 3

3. Acute illness

   • Moderate or severe acute illness with or without fever 1
   • Defer vaccination until the acute illness resolves

Conditions That Are NOT Contraindications

The following conditions are often mistakenly considered contraindications but do NOT preclude Tdap vaccination:

• Mild acute illness with or without low-grade fever 1
• Stable neurologic disorders (e.g., cerebral palsy, well-controlled seizures) 1
• Current antimicrobial therapy 1
• Convalescent phase of illness 1
• History of non-anaphylactic allergies (e.g., contact allergy to latex gloves) 1
• Family history of adverse events after pertussis vaccination 1
• Pregnancy (Tdap is actually recommended during each pregnancy) 1, 3

Special Considerations

1. Latex allergy

   • Some Tdap products (e.g., Boostrix needleless syringe) contain latex components and should not be administered to individuals with severe latex allergy 1
   • Alternative formulations without latex components are available 1

2. Repeat administration

   • Studies show that repeat Tdap administration, even at intervals less than 2 years from previous tetanus vaccination, has a favorable safety profile 4, 5, 6
   • A second dose of Tdap approximately 10 years after the first dose is well-tolerated and immunogenic 4, 6

Clinical Decision-Making Algorithm

1. Screen for absolute contraindications:

   • History of anaphylaxis to vaccine components? → Do not administer Tdap
   • History of encephalopathy within 7 days of pertussis vaccine? → Use Td instead

2. Evaluate precautions:

   • Recent Guillain-Barré syndrome? → Consider risk/benefit
   • Unstable neurologic condition? → Defer until stabilized
   • Recent Arthus reaction? → Consider deferring for 10 years
   • Moderate/severe acute illness? → Defer until resolved

3. For patients with history of anaphylaxis to all Tdap/Td components:

   • Refer to allergist for evaluation of specific tetanus toxoid allergy
   • Consider desensitization if protection against tetanus is critical