Tdap Vaccine Recommendations
Tdap (tetanus, diphtheria, and acellular pertussis) vaccine should be administered as a single dose to all adolescents aged 11-18 years and adults aged 19-64 years who have not previously received it, with either Td or Tdap now recommended for decennial boosters and wound management. 1
Routine Tdap Vaccination Recommendations
For Adolescents (11-18 years):
- Adolescents aged 11-18 years should receive a single dose of Tdap instead of Td for booster immunization against tetanus, diphtheria, and pertussis if they have completed the recommended childhood DTP/DTaP vaccination series and have not received Td or Tdap 1
- The preferred age for Tdap vaccination is 11-12 years to reduce morbidity associated with pertussis in adolescents 1
- Adolescents who previously received Td but not Tdap should receive a single dose of Tdap to provide protection against pertussis 1
For Adults (19-64 years):
- 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
- Since 2020, either Td or Tdap can be used for decennial booster doses, tetanus prophylaxis for wound management, and catch-up immunization schedules 1, 2
- Adults aged ≥65 years are also recommended to receive a single dose of Tdap (expanded recommendation from 2012) 1
Special Populations and Situations
Pregnant Women:
- Pregnant women should receive Tdap during each pregnancy, regardless of prior Tdap history 1, 3
- The recommended timing for maternal Tdap vaccination is between 27-36 weeks of gestation, preferably earlier in this window to maximize antibody transfer to the newborn 3
- Tdap may be safely given at any time during pregnancy if needed for wound management or pertussis outbreaks 3
Adults with Infant Contact:
- Adults who have or anticipate having close contact with an infant aged <12 months (e.g., parents, grandparents, childcare providers) should receive a single dose of Tdap if they have not previously received it 1
- Ideally, these adults should receive Tdap at least 2 weeks before beginning close contact with the infant 1
- This "cocooning" strategy helps protect infants who are too young to be vaccinated against pertussis 4
Healthcare Personnel:
- Healthcare personnel with direct patient contact should receive a single dose of Tdap as soon as feasible if they have not previously received it 1
- Tdap coverage among healthcare personnel was reported to be only 15.9% in 2008, highlighting the need for improved vaccination rates in this population 5
Intervals Between Vaccines
- An interval of at least 5 years between Td and Tdap was previously encouraged but is no longer required 1
- Since 2020, the Advisory Committee on Immunization Practices (ACIP) has updated recommendations to allow use of either Td or Tdap where previously only Td was recommended, increasing provider flexibility 1
- For healthcare personnel and those with infant contact, an interval as short as 2 years from the last dose of Td is acceptable 1
Booster Recommendations
- After receiving Tdap, subsequent tetanus and diphtheria protection should be maintained with Td or Tdap boosters every 10 years 2
- For wound management, a booster is appropriate if the patient has not received tetanus toxoid within the preceding 5 years for contaminated or tetanus-prone wounds 2
Common Pitfalls and Considerations
- Syncope (fainting) can occur after vaccination and may be more common among adolescents; a 15-20 minute observation period following vaccination is recommended 1
- Administration errors involving tetanus toxoid-containing vaccines are well-documented; attention to proper vaccination technique is important 1
- Low vaccination coverage remains a challenge, particularly among adults with infant contact (5.0%) and healthcare personnel (15.9%) 5
- Providers should not miss opportunities to administer Tdap during routine healthcare visits, as lack of adolescent visits is a commonly cited barrier to Tdap administration 6