What is the standard timing for Tdap (Tetanus, diphtheria, and pertussis) vaccination?

Standard Timing for Tdap Vaccination

Adolescents should receive a single dose of Tdap at age 11-12 years, and all adults who have never received Tdap should get one dose regardless of interval since their last tetanus-containing vaccine, followed by Td boosters every 10 years thereafter. 1, 2

Adolescent Vaccination (Ages 11-18 Years)

• Administer Tdap at age 11-12 years as the routine adolescent booster dose, replacing what was previously a Td booster 1, 2
• For adolescents aged 13-18 years who missed the 11-12 year dose, give Tdap as soon as feasible if they have not previously received it 1, 2
• This single dose provides critical protection during adolescence when pertussis transmission rates are high 1

Adult Vaccination (Ages ≥19 Years)

• All adults aged ≥19 years who have never received Tdap should receive one dose immediately, regardless of the interval since their last tetanus or diphtheria-containing vaccine 1, 2
• After receiving Tdap, continue with Td boosters every 10 years for routine maintenance 1, 2
• The previous recommendation requiring a 5-10 year interval between Td and Tdap has been eliminated—no minimum interval is necessary when Tdap is indicated 1

Special Population: Pregnancy

• Pregnant women should receive Tdap during each pregnancy at 27-36 weeks gestation, preferably during the earlier part of this window 1, 2, 3
• This recommendation applies to every pregnancy, even if the woman received Tdap previously, including during a prior pregnancy 1, 3
• Maternal vaccination during the third trimester provides 77.7% effectiveness against infant pertussis and 90.5% effectiveness against hospitalized cases in infants <2 months old 4
• Tdap may be safely administered at any time during pregnancy if needed for wound management or outbreak situations 3

Catch-Up Vaccination (Ages 7-10 Years)

• Children aged 7-10 years who did not receive the full DTaP series should receive a single dose of Tdap 1
• Even if Tdap is given at ages 7-10 years as part of catch-up, an additional Tdap dose should still be administered at age 11-12 years 1, 2
• If additional tetanus-containing doses are needed beyond the single Tdap dose, use Td vaccine 1

Adults Aged ≥65 Years

• Adults aged ≥65 years who have never received Tdap should receive one dose, with Boostrix preferred when feasible (though either product is acceptable) 1, 2
• The same "no minimum interval" rule applies—administer Tdap regardless of when the last Td was given 1, 2
• After Tdap, continue Td boosters every 10 years 1, 2

Healthcare Personnel

• All healthcare personnel with direct patient contact should receive a single dose of Tdap as soon as feasible if they have not previously received it 1
• No minimum interval from prior Td is required 1
• After Tdap, follow routine Td booster schedule every 10 years 1

Wound Management Context

• When tetanus-containing vaccine is indicated for wound management in persons aged ≥11 years who have not previously received Tdap (or whose Tdap history is unknown), Tdap is preferred over Td 1, 2
• For clean, minor wounds: tetanus-containing vaccine indicated if >10 years since last dose 1, 2
• For contaminated or tetanus-prone wounds: tetanus-containing vaccine indicated if >5 years since last dose 1, 2

Critical Clinical Principles

• Tdap is licensed and recommended as a single-dose vaccine for the general population (with the exception of pregnancy), not for repeated administration 1, 2
• The elimination of minimum interval requirements was based on accumulating data showing no increased risk of severe local reactions or serious adverse events when Tdap is given at short intervals after other tetanus or diphtheria-containing vaccines 1
• Do not administer DTaP to persons aged ≥7 years—use Tdap or Td instead 1, 2, 5

Common Pitfalls to Avoid

• Do not delay Tdap administration waiting for a 10-year interval from the last Td—this outdated practice reduces vaccination coverage 1
• Do not give tetanus boosters more frequently than every 10 years for routine immunization, as this can cause Arthus reactions (severe local hypersensitivity) 2, 6
• Do not miss opportunities to vaccinate adults aged ≥65 years with Tdap simply because they recently received Td 1, 2
• Do not restart the vaccination series if doses are delayed—simply continue from where the patient left off 1, 2