Can a 9-year-old receive the Tdap (Tetanus, diphtheria, and pertussis) vaccine?

Tdap Vaccination for 9-Year-Olds

Yes, a 9-year-old can receive the Tdap vaccine, and if administered, it should be counted as part of their catch-up immunization schedule, with the understanding that they will still need the routine adolescent Tdap dose at age 11-12 years. 1

Age-Specific Recommendations for Tdap

The FDA-approved Tdap vaccine (BOOSTRIX) is indicated for individuals aged 10 years and older 2. However, the Advisory Committee on Immunization Practices (ACIP) provides specific guidance for off-label administration to children aged 7-9 years:

• If Tdap is administered to a child aged 7-9 years:
  • This dose counts as part of their catch-up immunization schedule
  • The child should still receive the routine adolescent Tdap dose at age 11-12 years 1

Catch-Up Immunization Considerations

For children aged 7-9 years with incomplete immunization history:

• Tdap may be used as one of the doses in the catch-up series 1
• The vaccination series does not need to be restarted regardless of time elapsed between doses
• The preferred catch-up schedule for a child who has never been immunized is:
  1. First dose: Tdap
  2. Second dose: Td or Tdap (≥4 weeks after first dose)
  3. Third dose: Td or Tdap (6-12 months after second dose) 1

Special Situations

If DTaP is inadvertently administered to a 9-year-old (instead of Tdap):

• This dose should count as the Tdap dose in the catch-up series
• The child should still receive an adolescent Tdap dose at age 11-12 years 1

Clinical Considerations

Safety Profile

• The safety profile of Tdap in adolescents is generally comparable to that of Td vaccine 3
• Common side effects include local reactions at the injection site (pain, redness, swelling) and mild systemic symptoms (fatigue, headache)

Importance of Pertussis Protection

• Pertussis incidence has been increasing in the United States, particularly among adolescents 3, 4
• Undervaccination is associated with higher pertussis risk (adjusted relative risk 4.8 for the 3-dose primary series) 5
• Ensuring children receive all recommended doses of pertussis vaccine is critical for protection, even if there is some delay 5

Implementation Advice

• Administer Tdap as a 0.5 mL intramuscular injection into the deltoid muscle 2
• Tdap may be administered simultaneously with other age-appropriate vaccines at different anatomical sites 6
• The only absolute contraindication is a severe allergic reaction (anaphylaxis) to a previous dose or vaccine component 6, 2

Common Pitfalls to Avoid

• Don't skip the adolescent Tdap dose at age 11-12 years if Tdap was given at age 7-9 years
• Don't restart the vaccination series if there are gaps between doses
• Don't delay vaccination if the child is behind schedule, as undervaccination increases pertussis risk 5
• Don't withhold Tdap from a 9-year-old who needs tetanus protection (such as for wound management) if they haven't completed their primary series

By following these guidelines, clinicians can ensure appropriate protection against tetanus, diphtheria, and pertussis for 9-year-old children while maintaining the recommended immunization schedule.