Is a Tdap (Tetanus, diphtheria, and pertussis) booster due for a 68-year-old patient who received the last dose in 2022?

Tdap Booster Recommendation for a 68-Year-Old Patient

No, the 68-year-old patient who received a Tdap booster in 2022 is not due for another Tdap booster in 2025. After receiving Tdap, subsequent tetanus and diphtheria protection should be maintained with Td boosters every 10 years 1.

Current Immunization Status

• The patient received a Tdap booster in 2022 1
• It has only been 3 years since the last tetanus-containing vaccine 1
• The recommended interval between tetanus-containing vaccines is 10 years for routine boosting 2

Age-Specific Considerations

• While historically Tdap was not licensed for adults >65 years, current recommendations support its use in this population 2
• For adults ≥65 years, Boostrix (one Tdap product) is preferred, but either Tdap product is considered valid and immunogenic 2
• After receiving Tdap, subsequent doses should be Td for routine boosters every 10 years 1

Timing of Next Tetanus-Containing Vaccine

• The patient should receive their next tetanus-containing vaccine (Td) in 2032, which would be 10 years after their 2022 Tdap booster 2, 1
• Tdap is licensed for single-dose administration and is not recommended for routine repeat administration 2
• After receipt of Tdap, persons should receive Td for booster immunization against tetanus and diphtheria according to the standard 10-year interval 2

Special Considerations for Early Booster

• Early administration of a tetanus-containing vaccine would only be indicated in the following situations:
  • For wound management if it has been ≥5 years since the last tetanus-containing vaccine and the wound is contaminated 2, 3
  • During a pertussis outbreak situation 1
  • For pregnant women during each pregnancy, regardless of prior vaccination history 2

Clinical Pearls and Pitfalls

• Patient self-reporting of tetanus vaccination status has high sensitivity (92.4%) but low specificity (26.5%), meaning patients who report receiving a recent booster are likely accurate, but those who deny recent vaccination may be incorrect 4
• Research shows that a second dose of Tdap approximately 10 years after a previous dose is well-tolerated and immunogenic, though this is not currently part of routine recommendations 5
• The duration of protection against pertussis wanes over time, with an estimated 1.33 times increase in the odds of pertussis for each year after vaccination 6, but this does not change the current 10-year recommendation interval

In conclusion, this patient should not receive another tetanus-containing vaccine until 2032 unless they sustain a wound that requires earlier prophylaxis or fall into another special category requiring earlier administration.