Recommended Site for Tetanus (Td) Injections
For tetanus (Td) injections, the preferred administration site is the deltoid muscle in adolescents and adults, while the anterolateral thigh is recommended for infants and children through age 2 years. 1
Age-Specific Recommendations
- Infants and children through age 2 years: The preferred intramuscular injection site is the anterolateral aspect of the thigh 1
- Children aged ≥3 years: The preferred site is the deltoid muscle 1
- Adolescents and adults: The dose of Tdap is 0.5 mL, administered intramuscularly, preferably into the deltoid muscle 1
Specific Vaccine Formulations and Administration Sites
DTaP (for children <7 years)
- Dose: 0.5 mL administered intramuscularly 1
- Preferred site for infants and children through age 2 years: anterolateral aspect of the thigh 1
- Preferred site for children aged ≥3 years: deltoid muscle 1
DT (for children <7 years when pertussis component is contraindicated)
- Dose: 0.5 mL administered intramuscularly 1
- Preferred site for infants and children through age 2 years: anterolateral aspect of the thigh 1
- Preferred site for children aged ≥3 years: deltoid muscle 1
Tdap (for adolescents and adults)
Td (for adolescents and adults)
Clinical Considerations
- Research suggests that the deltoid muscle may be the preferred site for administration of tetanus-containing vaccines in older children (18 months) due to fewer reported severe pain reactions compared to thigh injections 2
- When administering multiple vaccines during the same visit, each vaccine should be administered using a separate syringe at a different anatomic site 1
- Some experts recommend administering no more than two injections per muscle, separated by at least one inch 1
- Healthcare providers should be aware of the potential for syncope after vaccination, especially among adolescents and young adults, and should take appropriate measures to prevent potential injuries 1
- Providers should strongly consider observing patients for 15 minutes after they are vaccinated 1
Needle Selection Considerations
- For intramuscular injections in infants using the WHO injection technique (skin stretched flat, needle inserted at a 90° angle), using 25 mm needles (either 23 G or 25 G) probably reduces the occurrence of local reactions compared to shorter 16 mm needles 3
- The evidence suggests that using a 25 mm needle for intramuscular vaccination in the anterolateral thigh of infants results in fewer severe local reactions compared to a 16 mm needle 3
Potential Pitfalls to Avoid
- Avoid using DTaP in individuals ≥7 years due to increased risk of local reactions 4
- Attention to proper vaccination technique, including use of an appropriate needle length and standard routes of administration, might minimize the risk for adverse events 1
- Avoid missing opportunities to administer Tdap to eligible adolescents and adults, especially those who will have contact with infants 4
- Be aware that if DTaP is inadvertently administered to a fully vaccinated child aged 7-10 years, this dose should be counted as the adolescent Tdap dose 4