Recommended Use and Administration of Tdap Vaccine
According to the 2020 Advisory Committee on Immunization Practices (ACIP) recommendations, either Tdap or Td vaccines can be used for decennial tetanus booster doses, tetanus prophylaxis for wound management in persons who previously received Tdap, and for multiple doses in the catch-up immunization schedule for persons aged ≥7 years with incomplete or unknown vaccination history. 1
Primary Recommendations for Tdap Administration
Adolescents aged 11-18 years should receive a single dose of Tdap instead of Td for booster immunization if they have completed the recommended childhood DTP/DTaP vaccination series and have not received Td or Tdap, with the preferred age being 11-12 years 1
Adults aged 19-64 years should receive a single dose of Tdap to replace a single dose of Td for active booster vaccination if they received their last dose of Td >10 years earlier 1
After receiving Tdap, subsequent tetanus and diphtheria protection should be maintained with Td or Tdap boosters every 10 years 1
The dose of Tdap is 0.5 mL, administered intramuscularly (IM), preferably into the deltoid muscle 1
Special Populations and Situations
Pregnant women: Should receive Tdap during each pregnancy, preferably between 27-36 weeks gestation (as early as possible in this window) to maximize maternal antibody transfer to the newborn 1, 2
Healthcare personnel: Those with direct patient contact should receive a single dose of Tdap as soon as feasible if they have not previously received Tdap 1
Adults with close contact to infants: Adults who have or anticipate having close contact with infants aged <12 months (e.g., parents, grandparents, childcare providers) should receive Tdap at least 2 weeks before beginning close contact if they haven't previously received it 1
Wound management: For tetanus prophylaxis in wound management, either Tdap or Td can be used if the patient has previously received Tdap; for pregnant women, Tdap is specifically recommended in this setting 1
Catch-up Immunization
For previously unvaccinated persons aged ≥7 years, the 3-dose catch-up immunization schedule should include 1 dose of Tdap (preferably as the first dose) and either Td or Tdap for the remaining doses 1
Children aged 7-10 years who receive Tdap as part of catch-up vaccination should still receive the routine adolescent Tdap dose at age 11-12 years 1
Timing and Intervals
An interval of at least 5 years between Td and Tdap was previously encouraged but is no longer required; shorter intervals may be used when pertussis protection is needed 1
The benefit of using Tdap at a shorter interval to protect against pertussis generally outweighs the risk for local and systemic reactions, particularly in settings with increased risk for pertussis or its complications 1
Co-administration with Other Vaccines
Tdap can be administered during the same visit as other vaccines (including meningococcal conjugate vaccine) if indicated and available 1
Each vaccine should be administered using a separate syringe at a different anatomic site 1
Available Products
- Two Tdap vaccines are licensed for use in the United States:
Safety Considerations
Tdap vaccines are generally safe and well tolerated in all age groups 3, 4
Local injection-site reactions are the most common adverse events, with most being mild to moderate in intensity and transient 3, 4
A 15-20 minute observation period following vaccination is suggested due to the possibility of syncope, which may be more common among adolescents and young adults 1
Recent research shows that a second dose of Tdap vaccine in adults approximately 10 years after a previous dose is well tolerated and immunogenic, supporting consideration of Tdap booster doses for adults 4
Studies have demonstrated no adverse effects on fertility or fetal development from Tdap vaccination 5
Common Pitfalls to Avoid
Failing to administer Tdap to pregnant women during each pregnancy, regardless of prior Tdap history 1, 2
Using DTaP (pediatric formulation) instead of Tdap in adolescents or adults, as DTaP contains higher antigen content that may increase reactogenicity 3, 6
Delaying Tdap administration when indicated due to concerns about interval since last tetanus-containing vaccine 1
Administration errors involving tetanus toxoid-containing vaccines and other products (e.g., administering Td instead of tuberculin purified protein derivative) 1