Tetanus Vaccine Coverage Period
Tetanus booster vaccination should be administered every 10 years throughout adult life to maintain protective immunity against tetanus and diphtheria. 1, 2
Standard Booster Schedule
All adults require a tetanus-containing vaccine (Td or Tdap) booster every 10 years after completing the primary vaccination series to ensure continued protection. 1, 3
Either Td or Tdap may be used for decennial boosters, providing flexibility in vaccine selection since the 2019 ACIP update. 1, 2
Adults who have never received Tdap should receive one dose of Tdap (instead of Td) for their next booster, regardless of the interval since their last tetanus-containing vaccine. 1
Primary Vaccination Series
The childhood primary series consists of five doses of DTaP administered at ages 2,4,6,15-18 months, and 4-6 years. 1
Adolescents should receive a single dose of Tdap at age 11-12 years, which serves as the first booster after the childhood series. 1, 3
Adults who have never been vaccinated require a 3-dose primary series: one dose of Tdap, followed by Td or Tdap at least 4 weeks later, then a third dose 6-12 months after the second dose. 1, 3, 4
Wound Management Exception
For tetanus-prone wounds (contaminated or severe), a booster is indicated if more than 5 years have elapsed since the last tetanus-containing vaccine. 1, 2, 3
For clean, minor wounds, a booster is only needed if more than 10 years have passed since the last dose. 3, 4
Tdap is preferred over Td for wound management in patients who have not previously received Tdap or whose Tdap history is unknown. 1, 4
Special Populations
Pregnant women should receive one dose of Tdap during each pregnancy (between 27-36 weeks gestation), regardless of prior vaccination history or interval since last tetanus vaccine. 1, 3
The 10-year booster interval applies throughout life, including for elderly individuals aged ≥65 years. 3, 4
Duration of Protection
Complete primary tetanus vaccination provides long-lasting protection of at least 10 years for most recipients, which forms the scientific basis for the decennial booster recommendation. 3, 5
Approximately 97% of vaccinated adults maintain protective antibody levels (≥0.01 IU/mL) against tetanus. 6
Critical Pitfalls to Avoid
Do not give tetanus boosters more frequently than every 10 years for routine immunization, as this can cause Arthus reactions and accentuate side effects. 3, 4
Do not restart the vaccination series if doses are delayed—simply continue from where the patient left off. 1, 4
Do not delay Tdap vaccination in adults who have never received it; administer as soon as feasible regardless of when they last received a tetanus-containing vaccine. 1
For wound management, do not delay tetanus prophylaxis when more than 5 years have elapsed for tetanus-prone wounds or more than 10 years for clean wounds. 4