What is the protocol for the Tdap (Tetanus, diphtheria, and pertussis) vaccine?

Tdap Vaccine Protocol

Tdap should be administered once in a lifetime for the general population (except during pregnancy), with all subsequent tetanus-diphtheria boosters given as Td every 10 years thereafter. 1

Primary Vaccination Schedule

Adults ≥18 Years

• For adults who have never received Tdap: Administer Tdap immediately, regardless of the interval since the last tetanus-containing vaccine 2, 1
• For adults who have previously received Tdap: Use Td for all routine 10-year boosters 1
• For unvaccinated adults: Give a 3-dose series with one dose being Tdap (preferred as the first dose), followed by Td at ≥4 weeks, then Td at 6-12 months 1

Adolescents and Children (Ages 7-18)

• Adolescent booster: Give one dose of Tdap at ages 11-12 years 2, 1
• Catch-up vaccination (ages 7-18): Give Tdap as the first dose, then use Td for any additional needed doses 1
• If Tdap given at ages 7-10: Still administer another Tdap dose at ages 11-12 years 1

Adults ≥65 Years

• Give Tdap if never received previously, preferably using Boostrix (approved for ages ≥10 years) over Adacel (approved for ages 10-64 years) 2
• However, either vaccine administered to persons aged ≥65 years is immunogenic and provides protection; providers may administer whichever Tdap vaccine they have available 2

Administration Details

Dosing and Route

• Dose: 0.5 mL administered intramuscularly 2
• Preferred injection site: Deltoid muscle for persons aged ≥3 years 2
• For infants and children through age 2 years: Anterolateral aspect of the thigh 2

Timing Considerations

• Tdap should be administered regardless of the interval since the last tetanus or diphtheria toxoid-containing vaccine 2, 1
• ACIP concluded that while longer intervals between Td and Tdap could decrease local reactions, the benefits of protection against pertussis outweigh the potential risk for adverse events 2

Special Populations

Pregnancy

• Administer Tdap during EACH pregnancy at 27-36 weeks gestation (preferably early in this window), regardless of prior Tdap history 1, 3
• This timing maximizes maternal antibody response and passive antibody transfer to the newborn 3
• Tdap may be safely given at any time during pregnancy if needed for wound management, pertussis outbreaks, or other circumstances 3

Healthcare Personnel

• All healthcare personnel should receive a single dose of Tdap as soon as feasible if not previously received 2
• For HCP in hospitals or ambulatory care settings with direct patient contact, Tdap should be given at an interval as short as 2 years following the last Td 2
• Priority should be given to HCP who have direct contact with infants aged <12 months 2

Immunocompromised Patients

• Persons with HIV infection or severe immunodeficiency should receive TIG regardless of their tetanus immunization history when they have contaminated wounds 1, 4

Wound Management Protocol

Clean, Minor Wounds

• Tetanus-containing vaccine indicated if >10 years since last dose 1, 4
• No TIG needed for patients with ≥3 previous doses 1, 4

Contaminated/Tetanus-Prone Wounds

• Tetanus-containing vaccine indicated if >5 years since last dose 1, 4
• For patients with ≥3 previous doses and last dose ≥5 years ago: Administer tetanus toxoid-containing vaccine WITHOUT TIG 1, 4
• For patients with <3 previous doses or unknown history: Administer BOTH tetanus toxoid-containing vaccine AND TIG (250 units IM) at separate anatomic sites 1, 4
• Tdap is strongly preferred over Td for those who have not previously received Tdap or whose Tdap history is unknown 1, 4

Pregnant Women Requiring Wound Prophylaxis

• Use Tdap regardless of prior Tdap history 1, 4

Important Clinical Considerations

Vaccine Product Selection

• Tdap is not licensed for multiple administrations (except during pregnancy) 2, 1
• After receiving Tdap, all subsequent routine boosters should be Td every 10 years 1
• If a dose of Tdap is administered to a person who has previously received Tdap, this dose should count as the next booster dose of tetanus toxoid-containing vaccine 2

Inadvertent Administration

• DTaP is not indicated for persons aged ≥7 years 2
• If DTaP is administered inadvertently to a person aged ≥11 years, this dose should count as the Tdap dose, and the person should not receive an additional dose of Tdap 2

Contraindications

• Tdap is contraindicated for persons with a history of serious allergic reaction (anaphylaxis) to any component of the vaccine 2
• Patients with a history of Arthus reaction should not receive tetanus toxoid-containing vaccine until >10 years after the most recent dose 1, 4

Common Pitfalls to Avoid

• Do not confuse the 10-year routine booster interval with the 5-year interval for contaminated wounds 4
• Do not restart the vaccination series if doses are delayed—simply continue from where the patient left off 1
• More frequent doses than recommended may be associated with increased incidence and severity of adverse reactions, including Arthus-type hypersensitivity reactions 2, 4

Simultaneous Vaccination

• Tdap may be administered simultaneously with other vaccines at different anatomical sites 2
• Each vaccine should be administered using a separate syringe 2