What is the recommended use of the TDAp (Tetanus, Diphtheria, and Pertussis) vaccine?

TDaP Vaccine Recommendations

The TDaP (Tetanus, Diphtheria, and Pertussis) vaccine is recommended as a single dose for adolescents aged 11-12 years, a single dose for adults aged 19-64 years who have not previously received TDaP, and for adults aged 65 years and older who have or are likely to have contact with infants younger than 12 months. 1

General Recommendations by Age Group

• Adolescents aged 11-18 years should receive a single dose of TDaP instead of Td, preferably at a preventive care visit at 11-12 years of age 1
• Adults aged 19-64 years should receive a single dose of TDaP to replace a single decennial Td booster if they have not previously received TDaP 1, 2
• Children 7-10 years of age who were not fully immunized with DTaP (did not receive 5 doses or 4 doses when the fourth dose was administered after the fourth birthday) should receive a single dose of TDaP 1
• Adults aged 65 years and older who have or are likely to have contact with an infant younger than 12 months (e.g., healthcare personnel, grandparents, and other caregivers) should receive a single dose of TDaP 1

Timing of TDaP Administration

• TDaP should be given when indicated and when no contraindication exists, regardless of interval since the last tetanus- or diphtheria-containing vaccine 1
• The previous recommendation for caution regarding TDaP use within a short interval after other tetanus- or diphtheria-containing toxoid products has been removed based on clinical trials showing no excess reactogenicity 1, 3
• For routine booster doses, TDaP or Td should be administered every 10 years to maintain protection 2, 4
• For wound management, a tetanus-containing vaccine is indicated when more than 5 years have elapsed since the last dose 2, 4

Special Populations

• Pregnant women should receive one dose of TDaP during each pregnancy, preferably between 27-36 weeks gestation, regardless of prior vaccination history 2
• Healthcare personnel who work in hospitals or ambulatory care settings and have direct patient contact should receive a single dose of TDaP as soon as feasible if they have not previously received TDaP 1
• Adults who have or anticipate having close contact with an infant aged <12 months should receive a single dose of TDaP to reduce the risk of transmitting pertussis 1
• When possible, women should receive TDaP before becoming pregnant; women who have not previously received TDaP should receive a dose in the immediate postpartum period 1

Vaccine Effectiveness and Safety

• TDaP elicits robust immune responses in adolescents and adults to pertussis, tetanus, and diphtheria antigens 5
• The overall safety profile of TDaP is similar to that of licensed Td vaccines 5
• Studies suggest TDaP provides protection against pertussis in outbreak settings, with an estimated vaccine effectiveness of 65.6% 6
• No serious adverse events related to TDaP vaccination have been reported in clinical trials, and the safety record for TDaP is excellent based on postmarketing adverse-events reports 1, 3

Common Pitfalls to Avoid

• Delaying TDaP administration due to concerns about intervals since previous tetanus-containing vaccines is unnecessary; TDaP can be safely administered at intervals of ≥18 months since a previous TD/Td vaccine 1, 3
• Failing to recognize that either Td or TDaP can be used for decennial booster doses since 2019, providing flexibility in vaccine selection 2
• Missing opportunities to vaccinate adults who have never received TDaP; they should receive one dose as soon as feasible 2, 7
• Not identifying individuals with infant contact who should receive TDaP to create a "cocoon" of protection around vulnerable infants 1

TDaP vaccination is a critical component of pertussis control strategy, especially given the increasing reports of pertussis among adolescents and adults who can transmit the infection to vulnerable infants 1, 7.