Is the Tdap (tetanus, diphtheria, and pertussis) vaccine required for a 95-year-old patient?

Tdap Vaccination for a 95-Year-Old Patient

Yes, a 95-year-old patient should receive Tdap if they have never received it previously, followed by Td boosters every 10 years for ongoing tetanus and diphtheria protection. 1

Current ACIP Recommendations for Elderly Adults

The Advisory Committee on Immunization Practices (ACIP) recommends that all adults aged 19 years and older who have not yet received a dose of Tdap should receive a single dose, regardless of age, including those ≥65 years. 1

• Tdap should be administered regardless of the interval since the last tetanus or diphtheria toxoid-containing vaccine 1
• After receipt of Tdap, persons should continue to receive Td for routine booster immunization every 10 years 1, 2
• Currently, Tdap is recommended only for a single dose across all age groups 1

Evolution of Guidelines for Older Adults

The recommendations have evolved significantly over time:

• 2006: Tdap was not licensed for use among adults aged >65 years, and the safety and immunogenicity were not studied during U.S. pre-licensure trials 1
• 2012: ACIP updated recommendations to include adults aged ≥65 years after reviewing safety and immunogenicity data 1
• 2018-2025: Current guidelines affirm that providers should not miss an opportunity to vaccinate persons aged ≥65 years with Tdap 1, 2

Product Selection for Elderly Patients

When feasible, Boostrix should be used for adults aged ≥65 years (approved for ages ≥10 years); however, either Tdap product (Boostrix or Adacel) administered to a person ≥65 years is immunogenic and would provide protection. 1

• A dose of either vaccine may be considered valid 1
• Providers may administer the Tdap vaccine they have available to avoid missing vaccination opportunities 1

Safety and Immunogenicity Evidence in Elderly

The evidence supporting Tdap use in older adults is robust:

• Clinical trials included 1,104 participants receiving Boostrix and 1,170 receiving Adacel aged ≥65 years 1
• The frequency and severity of adverse events in persons aged ≥65 years were comparable to those among persons aged <65 years 1
• No increase in local or generalized reactions was observed compared with Td recipients 1
• Postmarketing data from VAERS suggest the safety profile of Tdap in adults aged ≥65 years was comparable to Td vaccine 1
• For Boostrix, immune responses to pertussis antigens were noninferior to those following a 3-dose primary DTaP series, with geometric mean concentrations increasing 7.4-fold to 13.7-fold over baseline 1
• For Adacel, a 4.4-fold to 15.1-fold increase in anti-pertussis antibodies was observed 1

Clinical Algorithm for a 95-Year-Old Patient

Step 1: Determine Tdap vaccination history

• If never received Tdap → Administer Tdap now 1
• If previously received Tdap → Administer Td for routine 10-year booster 1, 2, 3

Step 2: After Tdap administration

• Schedule next tetanus-containing vaccine (Td) in 10 years 2, 3
• Tdap is licensed for single-dose administration only 3

Step 3: Special circumstances requiring earlier booster

• Contaminated or tetanus-prone wound: Administer tetanus-containing vaccine if ≥5 years since last dose 1, 2
• For wound management, Tdap is preferred over Td if the person has not previously received Tdap 1

Important Clinical Considerations

Rationale for vaccination at advanced age:

• Serosurveys indicate that 49%-66% of adults ≥60 years lack protective levels of circulating antitoxin against tetanus 2
• Pertussis cases have been steadily rising in recent decades, making vaccination paramount for disease prevention 4
• Protection against pertussis is particularly important for elderly adults who may have contact with infants 5

Common pitfalls to avoid:

• Do not withhold Tdap based solely on advanced age—the 2012 ACIP update specifically addressed this population 1
• Do not administer multiple doses of Tdap; it is licensed for single-dose administration only 3
• Do not restart the vaccination series if doses are delayed; simply continue from where the patient left off 2
• Do not give tetanus boosters more frequently than every 10 years for routine immunization to avoid Arthus reactions 2

Contraindications

Absolute contraindications include:

• History of neurologic or severe hypersensitivity/anaphylactic reaction to a previous dose 2
• History of encephalopathy within 7 days of a previous pertussis-containing vaccine not attributable to another cause 5