Tetanus Toxoid Dosing Recommendations
A single 0.5 mL intramuscular dose of tetanus toxoid-containing vaccine (Tdap or Td) is the standard dose for both adults and children aged 7 years and older, with specific timing based on vaccination history and clinical indication. 1
Primary Vaccination Series
For Previously Unvaccinated Individuals
- Adults and children ≥7 years who have never been vaccinated require a 3-dose primary series: one dose of Tdap (0.5 mL IM), followed by Td or Tdap at least 4 weeks later, then a third dose 6-12 months after the second dose 2, 1
- Children under 7 years receive DTaP as part of the childhood series: doses at 2,4,6,15-18 months, and 4-6 years 2
- If the vaccination schedule is delayed, simply continue from where the patient left off—never restart the series 2
Adolescent and Adult Booster Dosing
Standard Booster Schedule
- Adolescents aged 11-12 years should receive a single 0.5 mL dose of Tdap as their first booster after the childhood DTaP series 3, 2
- All adults require a tetanus-containing vaccine (Td or Tdap) booster every 10 years after completing the primary vaccination series 2, 1
- Adults who have never received Tdap should receive one 0.5 mL dose of Tdap (instead of Td) for their next booster, regardless of the interval since their last tetanus-containing vaccine 3
No Minimum Interval Required
- There is no minimum interval required or advised between receipt of a tetanus toxoid- or diphtheria toxoid-containing vaccine and Tdap when Tdap is otherwise indicated 3
- This represents a critical change from earlier recommendations that required a 5-year minimum interval, as accumulating data demonstrate no increased risk of severe local reactions or serious adverse events with shorter intervals 3
Special Population Dosing
Children 7-10 Years with Incomplete Vaccination
- A single 0.5 mL dose of Tdap should be given to children 7-10 years of age who have incomplete or unknown pertussis vaccine history (i.e., have not received 5 doses of DTP/DTaP or 4 doses when the fourth dose was administered after the fourth birthday) 3
- Only 1 dose of Tdap is recommended at this time, as Tdap vaccines are not licensed for multiple doses 3
Adults ≥65 Years
- A single 0.5 mL dose of Tdap should be given to adults of any age (including those aged 65 years or older) who have not received Tdap previously, who are health care personnel, or who have or anticipate having close contact with an infant younger than 12 months 3
- The 10-year booster interval applies throughout life, including for elderly individuals 2
Pregnant Women
- Pregnant women should receive one 0.5 mL dose of Tdap during each pregnancy (between 27-36 weeks gestation), regardless of prior vaccination history or interval since last tetanus vaccine 2, 4
Wound Management Dosing
Contaminated or Tetanus-Prone Wounds
- For patients with ≥3 previous doses: Administer 0.5 mL of tetanus-containing vaccine if more than 5 years have elapsed since the last dose (Tdap preferred if never received Tdap previously; otherwise Td) 2, 5, 1
- For patients with <3 previous doses or unknown history: Administer both 0.5 mL tetanus-containing vaccine AND Tetanus Immune Globulin (TIG) 250 units IM at separate anatomic sites 2, 5
Clean, Minor Wounds
- For patients with ≥3 previous doses: Administer 0.5 mL of tetanus-containing vaccine only if ≥10 years have elapsed since the last dose 2, 5
- For patients with <3 previous doses or unknown history: Administer both 0.5 mL tetanus-containing vaccine AND TIG 250 units IM 5
Critical Dosing Considerations
Route and Volume
- Each dose is 0.5 mL administered intramuscularly 1
- When administering TIG concurrently with tetanus toxoid, use separate syringes at different anatomical sites 2, 5
Common Pitfalls to Avoid
- Do not give tetanus boosters more frequently than every 10 years for routine immunization, as this can cause Arthus reactions and accentuate side effects 2, 4
- Do not confuse the 10-year routine booster interval with the 5-year interval for contaminated wounds—this is the most common error in tetanus prophylaxis 5
- Do not administer DTaP to persons aged ≥7 years; use Tdap or Td instead 4