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

Contraindications to Tdap Booster Vaccination

Absolute contraindications to Tdap booster vaccination include a history of severe allergic reaction (anaphylaxis) to a previous dose or any vaccine component, and a history of encephalopathy within 7 days of a previous pertussis-containing vaccine. 1, 2, 3

Absolute Contraindications

1. Severe allergic reaction (anaphylaxis)

   • Previous anaphylactic reaction to any component of Tdap vaccine
   • Previous anaphylactic reaction to a prior dose of Tdap or other tetanus/diphtheria/pertussis-containing vaccine 2, 3

2. Neurological contraindications (for pertussis component only)

   • History of encephalopathy (e.g., coma or prolonged seizures) not attributable to another identifiable cause within 7 days after administration of a previous pertussis-containing vaccine 1
   • In these cases, Td (tetanus-diphtheria) should be administered instead of Tdap 1

Precautions (Require Clinical Assessment)

These conditions require careful evaluation of risks and benefits before administering Tdap:

1. Neurological conditions

   • Progressive neurologic disorder
   • Uncontrolled epilepsy
   • Progressive encephalopathy until the condition has stabilized 1

2. History of adverse reactions

   • Guillain-Barré syndrome within 6 weeks after a previous tetanus toxoid-containing vaccine 1, 2
   • History of Arthus-type hypersensitivity reaction after a previous tetanus or diphtheria toxoid-containing vaccine (consider deferring vaccination for at least 10 years since last dose) 1
   • Previous severe local reaction (ELS) after DTP/DTaP or Td that was not an Arthus reaction 1

3. Acute illness

   • Moderate or severe acute illness with or without fever (defer until resolution) 1, 2

Not Contraindications

The following conditions are NOT contraindications to Tdap vaccination:

• Stable neurologic disorders, including well-controlled seizures
• History of seizure disorder that has resolved
• Cerebral palsy
• Breastfeeding
• Mild acute illness with or without low-grade fever
• Current antibiotic therapy
• Convalescent phase of illness
• Premature birth (for age-appropriate vaccinations)
• Recent exposure to an infectious disease
• History of non-anaphylactic allergies to medications, foods, insects, or other allergens 1, 2

Special Considerations

1. Latex sensitivity

   • Some Tdap prefilled syringes may contain latex in the tip caps, which could cause allergic reactions in latex-sensitive individuals 2, 3

2. Timing of vaccination

   • While earlier guidelines suggested waiting 10 years between tetanus-containing vaccines, more recent research indicates that Tdap can be safely administered at intervals of ≥18 months after a previous tetanus-containing vaccine 4, 5
   • Repeated Tdap vaccination has been shown to have acceptable safety compared to Tdap followed by Td vaccination 5

3. Management when contraindicated

   • For individuals with contraindications to the pertussis component, Td vaccine should be used instead of Tdap 1
   • Persons with a history of anaphylaxis to components in all Tdap and Td vaccines should be referred to an allergist to determine if they have a specific allergy to tetanus toxoid and whether they can safely receive tetanus toxoid vaccination 1

By carefully evaluating these contraindications and precautions, healthcare providers can safely administer Tdap boosters to appropriate candidates while minimizing risks of adverse events.