How often do you need a tetanus (Td or Tdap) vaccination?

Tetanus Vaccination Schedule and Recommendations

Tetanus booster vaccinations (Td or Tdap) are recommended every 10 years throughout life to maintain protection against tetanus and diphtheria. 1

General Tetanus Vaccination Schedule

• After completing the primary childhood immunization series, a booster dose of tetanus-containing vaccine is recommended every 10 years to ensure continued protection against tetanus and diphtheria 1
• Either Td (tetanus and diphtheria) or Tdap (tetanus, diphtheria, and acellular pertussis) can be used for these decennial booster doses, as per the 2019 Advisory Committee on Immunization Practices (ACIP) updated recommendations 1
• The first tetanus booster for adolescents should be Tdap at age 11-12 years, regardless of when the last tetanus-containing vaccine was given 1, 2

Special Considerations

• Pregnant women should receive one dose of Tdap during each pregnancy, preferably between 27-36 weeks gestation, regardless of prior vaccination history 1
• For wound management, a tetanus-containing vaccine is indicated when more than 5 years have elapsed since the last dose 1, 3
• For persons who have never been vaccinated against tetanus, a 3-dose primary series is recommended: 1 dose of Tdap, followed by either Td or Tdap at least 4 weeks later, and a third dose of either Td or Tdap 6-12 months after the second dose 1

Flexibility in Vaccine Selection

• Since October 2019, ACIP has allowed either Td or Tdap to be used in situations where previously only Td was recommended 1
• This increased flexibility applies to decennial booster doses, tetanus prophylaxis for wound management, and catch-up immunization schedules 1
• For persons who have never received Tdap, it is preferred over Td for the next tetanus booster 1, 3

Safety Considerations

• Studies have shown that Tdap is safe and immunogenic even when administered at intervals shorter than 10 years after a previous tetanus-containing vaccine 1, 4
• No whole limb swelling, Arthus-like reactions, or serious adverse events were reported when Tdap was administered as soon as 18 months after a previous tetanus-containing vaccine 4
• Persons with a history of Arthus reaction following a previous tetanus toxoid-containing vaccine should not receive a tetanus toxoid-containing vaccine until more than 10 years after the most recent dose 1

Emerging Research

• Recent research suggests that protective immunity against tetanus and diphtheria may last longer than previously thought, with antibody responses to tetanus declining with an estimated half-life of 14 years and diphtheria with a half-life of 27 years 5
• Mathematical models predict that 95% of the vaccinated population may remain protected against tetanus and diphtheria for 30 years or more without requiring booster vaccination 5
• Despite these findings, the current ACIP recommendation for decennial boosters remains the standard of care 1

Common Pitfalls to Avoid

• Delaying Tdap vaccination in adults who have never received it - ACIP recommends that adults who have never received Tdap should get one dose as soon as feasible 1
• Assuming all wounds require immediate tetanus vaccination - only wounds in patients whose last tetanus vaccination was more than 5 years ago require tetanus prophylaxis 1, 3, 6
• Failing to recognize that either Td or Tdap can now be used for booster doses - the 2019 ACIP update provides flexibility in vaccine selection 1