What is the recommended tetanus vaccination schedule?

Tetanus Vaccination Schedule

The recommended tetanus vaccination schedule includes a primary series in childhood followed by Tdap at age 11-12 years and booster doses of either Td or Tdap every 10 years throughout life to ensure continued protection against tetanus and diphtheria. 1

Childhood Vaccination Schedule

• The primary series for tetanus vaccination consists of three doses administered at 4-8 week intervals, followed by a fourth (reinforcing) dose 6-12 months after the third dose 1
• The fourth dose may be administered as early as 12 months of age if at least 6 months have elapsed since the third dose 1
• A fifth dose is typically given at 4-6 years of age as part of the childhood immunization schedule 1

Adolescent and Adult Vaccination

• Persons aged 11-18 years should receive a single dose of Tdap (tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis), preferably at age 11-12 years 1
• After receiving Tdap, booster doses of either Td or Tdap should be administered every 10 years throughout life to maintain protection 1
• Adults aged ≥19 years who have never received Tdap should get one dose of Tdap regardless of when they last received a tetanus-containing vaccine, followed by either Td or Tdap boosters every 10 years 1

Special Populations

Pregnant Women

• Pregnant women should receive one dose of Tdap during each pregnancy, regardless of prior vaccination history 1
• Tdap should be administered between 27-36 weeks' gestation, preferably during the earlier part of this period 1

Wound Management

• For tetanus-prone wounds, a tetanus toxoid-containing vaccine is indicated when >5 years have passed since the last tetanus toxoid-containing vaccine dose 1
• For persons ≥11 years who have not previously received Tdap or whose Tdap history is unknown, Tdap is preferred over Td for wound management 1
• For pregnant women requiring tetanus prophylaxis for wound management, Tdap should be used 1

Catch-up Vaccination

Children and Adolescents (7-18 years)

• Unvaccinated persons aged 7-18 years should receive a series of three tetanus and diphtheria toxoid-containing vaccines, which includes at least 1 Tdap dose 1
• The preferred schedule is 1 dose of Tdap, followed by 1 dose of either Td or Tdap ≥4 weeks afterward, and 1 dose of either Td or Tdap 6-12 months later 1

Adults (≥19 years)

• Unvaccinated adults should receive a series of three tetanus and diphtheria toxoid-containing vaccines, which includes 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

Important Considerations

• The vaccination series does not need to be restarted for those with incomplete history, regardless of the time elapsed between doses 1
• Recent evidence suggests that after completing the childhood vaccination series, decennial booster vaccinations may not be necessary for maintaining protective immunity in the general population 2, 3
• However, current ACIP guidelines still recommend the 10-year booster schedule to ensure continued protection 1
• Tetanus toxoid is highly effective, with disease incidence falling to less than one case per 10 million person-years in countries with robust vaccination programs 2

Pitfalls to Avoid

• Do not administer DTaP to persons aged ≥7 years; use Tdap or Td instead 1
• Do not miss the opportunity to administer Tdap to adults who have never received it, regardless of when they last received Td 1
• Avoid unnecessary administration of tetanus toxoid for minor, clean wounds in fully immunized individuals (≥3 doses) if the last dose was given within 10 years 4, 5
• Remember that tetanus immunoglobulin should be reserved for patients with wounds who have never received primary immunization against tetanus 5