Adult Tdap Vaccination Requirements
Adults should receive a single dose of Tdap vaccine to replace one dose of Td for booster vaccination against tetanus, diphtheria, and pertussis, followed by Td boosters every 10 years thereafter. 1
General Recommendations for Adults
- Adults aged 19-64 years who have never received Tdap should get a single dose of Tdap instead of their next Td booster
- After receiving Tdap, adults should continue getting Td boosters every 10 years
- Tdap can be given regardless of when the last Td vaccine was received, especially in situations with increased pertussis risk 1
Special Populations and Considerations
Adults with Close Contact to Infants
- Adults who have or anticipate having close contact with infants under 12 months should receive Tdap regardless of when they last received Td
- This includes parents, grandparents under 65, childcare providers, and healthcare personnel
- Ideally, these adults should receive Tdap at least 2 weeks before beginning close contact with the infant 1
Pregnant Women
- Women should receive Tdap during each pregnancy, preferably between 27-36 weeks gestation
- If not vaccinated during pregnancy, women should receive Tdap immediately postpartum 1
Healthcare Personnel
- Healthcare personnel with direct patient contact should receive a single dose of Tdap as soon as feasible if they haven't previously received it
- An interval as short as 2 years from the last Td is acceptable for these individuals 1
Adults with No Previous Tetanus-Containing Vaccines
- Adults with no documentation of tetanus, diphtheria, or pertussis vaccination should receive:
- A single dose of Tdap
- Followed by a dose of Td ≥4 weeks after Tdap
- Another dose of Td 6-12 months later 1
Available Tdap Products
As of the 2006 guidelines, only ADACEL® was licensed for use in adults aged 19-64 years 1. However, more recent research indicates that both Adacel and Boostrix are now approved for use in adults:
- Boostrix: A three-component acellular pertussis vaccine combined with reduced-antigen content tetanus and diphtheria toxoids 2, 3, 4
- Adacel: A five-component acellular pertussis vaccine combined with reduced-antigen content tetanus and diphtheria toxoids 2
Revaccination with Tdap
While the original guidelines indicated Tdap was licensed for single use only 1, more recent research suggests that a second dose of Tdap approximately 10 years after the initial dose is well-tolerated and immunogenic 5. This data may support consideration for providing Tdap booster doses to adults, though official recommendations may vary.
Common Pitfalls and Caveats
Inadvertent administration: Vaccine providers should carefully check product labels before administration to avoid giving pediatric DTaP or age-inappropriate formulations to adults 1
Adults aged ≥65 years: The original guidelines did not include recommendations for this age group due to limited data 1, but more recent research suggests Tdap is immunogenic and well-tolerated in older adults 3, 4
Incomplete protection: A single Tdap dose may not provide lifelong immunity against pertussis; antibody levels begin to decline within 5 years after vaccination 4
Undervaccination: Many adults are unaware of the need for Tdap vaccination, potentially contributing to pertussis transmission to vulnerable populations, particularly infants 6
By following these recommendations, healthcare providers can help reduce the morbidity associated with pertussis in adults and decrease the risk of transmitting pertussis to vulnerable populations, particularly infants who are at highest risk for pertussis-related complications and death.