What is the recommended catch-up series for an 8-year-old child who has only received one dose of Diphtheria, Tetanus, and Pertussis (DTaP) vaccine?

Catch-Up Vaccination for an 8-Year-Old with One Prior DTaP Dose

An 8-year-old child who has received only one dose of DTaP should receive Tdap immediately as the next dose (preferably as the first dose of the catch-up series), followed by Td at least 4 weeks later, and a final Td dose 6-12 months after the second dose, for a total of 3 doses to complete the series. 1

Age-Appropriate Vaccine Selection

• At 8 years old, this child should receive Tdap (not DTaP) for catch-up vaccination because DTaP is not indicated for persons aged ≥7 years 1
• The first dose in the catch-up series should preferably be Tdap, with subsequent doses using Td vaccine 1
• This differs from younger children (<7 years) who would receive DTaP for all catch-up doses 2

Complete Catch-Up Schedule

The recommended 3-dose series consists of: 1

1. Dose 1 (immediate): Tdap
2. Dose 2 (≥4 weeks after dose 1): Td
3. Dose 3 (6-12 months after dose 2): Td

Critical Principle: Never Restart the Series

• The single DTaP dose this child received previously counts toward the series and should not be discarded 1, 2
• The vaccination series does not need to be restarted regardless of how much time has elapsed between doses 1, 2
• Only 2 additional doses are needed to complete the 3-dose primary series 1

Important Consideration for Adolescent Booster

• Because this child will receive Tdap at age 8 years as part of catch-up, an additional adolescent Tdap booster dose should still be administered at age 11-12 years 1
• This is a specific ACIP recommendation for children aged 7-10 years who receive Tdap during catch-up vaccination 1
• The rationale is that Tdap given before age 10 as part of catch-up does not replace the routine adolescent booster dose 1

Common Pitfall to Avoid

• Do not confuse Td with Tdap when ordering vaccines for this age group 3
• Providers should carefully review product labels before administration, as packaging may appear similar 1, 3
• Do not give DTaP to this 8-year-old child, as it is not licensed or indicated for children ≥7 years old and contains higher amounts of diphtheria toxoid associated with increased adverse reactions in older persons 1
• If DTaP is inadvertently administered to this 8-year-old during catch-up, it should count as the Tdap dose of the catch-up series, and the child should still receive an adolescent Tdap booster at age 11-12 years 1

Maximum Dose Consideration

• The total number of doses of vaccines containing diphtheria and tetanus toxoids should not exceed 6 doses before the seventh birthday 1
• Since this child is already 8 years old, this maximum dose concern does not apply 1