Tdap Booster Frequency
Tdap (or Td) should be administered every 10 years as a routine booster dose throughout adult life. 1, 2, 3
Standard Booster Schedule
The Advisory Committee on Immunization Practices (ACIP) recommends decennial (every 10 years) booster doses of either Td or Tdap for all adults who have completed their primary vaccination series. 4, 1, 3 This 10-year interval applies throughout life, including for elderly individuals aged ≥65 years. 2, 3
Since 2019, ACIP guidelines provide flexibility in vaccine selection, allowing either Td or Tdap to be used for routine 10-year boosters. 4, 1 Previously, only Td was recommended for subsequent doses after the initial Tdap, but current recommendations permit either vaccine. 4, 3
Key Timing Considerations
First Tdap Dose
- Adults who have never received Tdap should receive one dose as soon as feasible, regardless of the interval since their last tetanus-containing vaccine. 1, 2, 3
- Tdap should be administered regardless of when the last Td was given—do not delay. 1, 3
Subsequent Boosters
- After receiving Tdap, continue with either Td or Tdap boosters every 10 years. 2, 3
- The vaccination series does not need to be restarted if doses are delayed—simply continue from where the patient left off. 2, 3
Important Exceptions to the 10-Year Rule
Wound Management (5-Year Rule)
For contaminated or tetanus-prone wounds, a booster is indicated if more than 5 years have elapsed since the last tetanus-containing vaccine. 1, 2, 3 This shorter interval applies specifically to wound management, not routine prophylaxis. 1, 3
- Tdap is preferred over Td for wound management in patients who have not previously received Tdap or whose Tdap history is unknown. 2, 3
- Clean, minor wounds only require a booster if the last dose was more than 10 years ago. 1
Pregnancy
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, 2, 5 This recommendation applies even if the woman received Tdap less than 10 years ago. 5
Critical Pitfalls to Avoid
Do not give tetanus boosters more frequently than every 10 years for routine immunization. 1, 3 Administering boosters too frequently can cause Arthus-type hypersensitivity reactions—severe local reactions characterized by pain, swelling, and induration developing 4-12 hours post-injection. 1, 6
- Persons who experienced an Arthus reaction following a previous tetanus toxoid-containing vaccine should not receive another dose until at least 10 years have elapsed. 1, 6
- The only exceptions to the 10-year minimum interval are wound management (5-year rule) and pregnancy (any interval). 1, 2, 3
Evidence Supporting the 10-Year Interval
Complete primary tetanus vaccination provides long-lasting protection of ≥10 years for most recipients, which forms the scientific basis for the decennial booster recommendation. 1 Clinical trials demonstrate that repeat doses of Tdap at 10-year intervals are safe and highly immunogenic. 4, 7, 8
A study of young adults receiving a second Tdap booster 10 years after their first showed the vaccine was highly immunogenic and well tolerated, with antibody responses similar in magnitude to the initial booster. 7 This supports the use of Tdap as a decennial booster. 7, 8