What DTaP (Diphtheria, Tetanus, and Pertussis) vaccine is recommended for an elderly man?

Tdap Vaccination for Elderly Men

An elderly man who has never received Tdap should receive a single dose of Tdap now, regardless of when he last received a tetanus-containing vaccine, with Boostrix preferred when feasible, though either Tdap product is acceptable. 1

Primary Recommendation for Elderly Adults

• All adults aged 65 years and older who have not previously received Tdap should receive a single dose. 1
• Tdap should be administered regardless of the interval since the last tetanus or diphtheria toxoid-containing vaccine—there is no minimum waiting period required. 1, 2
• After receiving Tdap, the patient should continue with Td boosters every 10 years for routine tetanus and diphtheria protection. 1, 2

Product Selection for Elderly Patients

• Boostrix is the preferred Tdap product for adults aged 65 years and older when feasible. 1
• However, either Tdap product (Boostrix or Adacel) is acceptable and considered valid—both are immunogenic and provide protection in this age group. 1
• Providers should not miss an opportunity to vaccinate and may administer whichever Tdap vaccine they have available. 1

The evidence supporting this recommendation is robust: ACIP updated guidelines in 2012 specifically to include adults ≥65 years after reviewing safety and immunogenicity data from clinical trials involving 1,104 participants receiving Boostrix and 1,170 receiving Adacel in this age group. 1, 3 The safety profile was comparable to Td vaccine, with no increase in adverse events compared to younger adults. 1, 3

Immunogenicity Evidence

• Boostrix demonstrated noninferior immune responses to pertussis antigens compared to a 3-dose primary DTaP series in infants, with antibody concentrations increasing 7.4-fold to 13.7-fold over baseline. 1
• Adacel showed a 4.4-fold to 15.1-fold increase in anti-pertussis antibodies, and ACIP concluded it would likely provide protection despite some antigens not meeting predefined noninferiority criteria. 1
• Seroprotection rates for diphtheria and tetanus were achieved in essentially all recipients (≥99.9%). 4, 3

Critical Clinical Algorithm

Step 1: Determine Tdap History

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

Step 2: Select Product (if Tdap indicated)

• First choice: Boostrix 1
• Acceptable alternative: Adacel 1
• Use whichever product is available to avoid missing vaccination opportunity 1

Step 3: Schedule Future Boosters

• Next booster: Td in 10 years 1, 2, 5
• Exception: Wound management may require earlier booster if ≥5 years elapsed and wound is contaminated 1, 2

Important Caveats and Pitfalls

• Do NOT delay Tdap waiting for a specific product—both are acceptable and missing the vaccination opportunity is worse than using the available product. 1
• Do NOT give Tdap more than once for routine immunization (single lifetime dose, except pregnancy)—subsequent boosters should be Td. 1, 2, 6
• Do NOT administer tetanus boosters more frequently than every 10 years for routine immunization, as this can cause Arthus reactions (severe local hypersensitivity). 2
• Do NOT use DTaP (pediatric formulation) in adults—only Tdap or Td are appropriate. 2, 6

Special Considerations for Elderly Population

The rationale for vaccinating elderly adults is particularly compelling: serosurveys indicate that 49%-66% of adults ≥60 years lack protective levels of circulating antitoxin against tetanus, making this population especially vulnerable. 2 Additionally, elderly adults can transmit pertussis to infants and young children, and pertussis can cause significant morbidity in this age group. 7, 3

Wound Management Exception

If this elderly man presents with a contaminated or tetanus-prone wound and it has been >5 years since his last tetanus-containing vaccine, Tdap is preferred over Td if he has never received Tdap. 1, 2 For clean, minor wounds, the interval extends to 10 years. 2