Tdap and COVID-19 Booster Recommendations
For Tdap vaccination, either Td or Tdap can be used for booster doses every 10 years, with Tdap preferred if the patient has not previously received it. 1
Tdap Vaccination Recommendations
General Recommendations
- Adults should receive a single dose of Tdap to replace a single dose of Td for active booster vaccination against tetanus, diphtheria, and pertussis if they received their last dose of Td >10 years earlier 1
- After receiving Tdap, subsequent tetanus and diphtheria protection should be maintained with either Td or Tdap boosters every 10 years 1, 2
- The dose of Tdap is 0.5 mL, administered intramuscularly, preferably into the deltoid muscle 1
Special Considerations
- If tetanus toxoid-containing vaccine is indicated for wound management, Tdap is preferred for persons who have not previously received Tdap 1
- For persons who have already received Tdap, either Td or Tdap may be used if a tetanus toxoid-containing vaccine is indicated for wound management 1
- Adults who have or anticipate having close contact with infants aged <12 months should receive a single dose of Tdap at intervals <10 years since the last Td to protect against pertussis if they have not previously received Tdap 1
- Tdap has been shown to be immunogenic and well-tolerated when administered as a second dose approximately 10 years after the first dose 3, 4
Catch-up Immunization
- For adults who have never been vaccinated against pertussis, tetanus, or diphtheria, a series of three tetanus and diphtheria toxoid-containing vaccines is recommended, which should include at least 1 Tdap dose 1
- The preferred schedule is 1 dose of Tdap, followed by 1 dose of either Td or Tdap at least 4 weeks afterward, and 1 dose of either Td or Tdap 6–12 months later 1
Safety and Efficacy
- Studies show that a second dose of Tdap vaccine in adults approximately 10 years after a previous dose is well tolerated and immunogenic 3
- Local injection-site reactions are the most common adverse events, with pain at the injection site reported in 75% of recipients 2, 5
- Most adverse events are of mild or moderate intensity and transient; serious vaccination-related adverse events are rare 5
- Antibody levels to pertussis antigens begin to decline by 5 years after a booster dose of Tdap, supporting the potential benefit of periodic boosters 6
Simultaneous Administration
- If two or more vaccines are indicated, they should be administered during the same visit (simultaneous vaccination) 1
- Each vaccine should be administered using a separate syringe at a different anatomic site 1
- Administering all indicated vaccines during a single visit increases the likelihood that adults will receive recommended vaccinations 1
COVID-19 Booster Recommendations
While specific COVID-19 booster information was not provided in the evidence, current practice generally supports:
- COVID-19 boosters can be administered simultaneously with other vaccines, including Tdap 2
- The benefits of receiving both vaccines when indicated generally outweigh any potential risks of co-administration
Common Pitfalls to Avoid
- Administering pediatric DTaP vaccine formulations to adults instead of the appropriate adult Tdap formulation 1
- Delaying Tdap vaccination when indicated, as the benefits of protection against pertussis generally outweigh the risks of local and systemic reactions 1
- Failing to recognize that Tdap can now be used for any dose in the tetanus-diphtheria series, which increases provider flexibility 1
- Not maintaining proper vaccination records, which can lead to unnecessary vaccinations 1