- Overview of Immunization
- Chikungunya Vaccine
- COVID-19 Vaccine
- Diphtheria-Tetanus-Pertussis Vaccine
- Ebola Vaccine
- Haemophilus influenzae Type b (Hib) Vaccine
- Hepatitis A (HepA) Vaccine
- Hepatitis B (HepB) Vaccine
- Herpes Zoster Vaccine
- Human Papillomavirus (HPV) Vaccine
- Influenza Vaccine
- Measles, Mumps, and Rubella (MMR) Vaccine
- Meningococcal Vaccine
- Mpox Vaccine
- Pneumococcal Vaccine
- Poliomyelitis Vaccine
- Respiratory Syncytial Virus (RSV) Vaccine
- Rotavirus Vaccine
- Tetanus-Diphtheria Vaccine
- Varicella Vaccine
- Passive Immunization
A vaccine for tetanus alone is available, but the tetanus vaccine is typically combined with those for diphtheria and/or pertussis (diphtheria/tetanus toxoids/pertussis vaccine). The vaccine for diphtheria is available only in combination with other vaccines.(diphtheria/tetanus toxoids/pertussis vaccine). The vaccine for diphtheria is available only in combination with other vaccines.
(See also Overview of Immunization.)
Preparations of Tetanus-Diphtheria Vaccine
The most widely used preparations combine tetanus toxoid with diphtheria toxoid (Td):
For adolescents and adults: Td or Tdap
For children: DT, which contains a higher dose of diphtheria toxoid (diphtheria toxoid/tetanus toxoid adsorbed, DT, Td)For children: DT, which contains a higher dose of diphtheria toxoid (diphtheria toxoid/tetanus toxoid adsorbed, DT, Td)
A preparation with only tetanus toxoid (TT) is also available but is not recommended because periodic boosting is needed for both antigens.
Tetanus-diphtheria-pertussis (Tdap) is an adolescent and adult preparation that contains a pertussis component.
DT is no longer available in the United States.
Indications for Tetanus-Diphtheria Vaccine
Td or Tdap boosters are administered routinely every 10 years after the Tdap booster is administered at age 11 to 12 years. Patients who have not received or completed a primary vaccination series of at least 3 doses of tetanus and diphtheria vaccine (including Tdap) should begin or complete the series (1–3).
Patients who have a wound that poses an increased risk of tetanus (see table Tetanus Prophylaxis in Routine Wound Management) should be given a Td or Tdap booster if ≥ 5 years have elapsed since the previous dose. One dose of Tdap should be substituted for a Td booster if adults have never received Tdap (1).
Pregnant patients should receive 1 dose of Tdap during each pregnancy, irrespective of their history of receiving the vaccine. Tdap should be administered at 27 to 36 weeks gestation, preferably during the earlier part of this period, although it may be administered at any time during pregnancy (4).
In children who develop a contraindication to pertussis-containing vaccines (ie, DTaP or Tdap), the Td vaccine can be used off-label following the same schedule as for DTaP; however, this may result in suboptimal protection against diphtheria. (See also CDC: About Young Children with a Contraindication to Pertussis-Containing Vaccines.)
Indications references
1. Havers FP, Moro PL, Hunter P, Hariri S, Bernstein H. Use of Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis Vaccines: Updated Recommendations of the Advisory Committee on Immunization Practices - United States, 2019. MMWR Morb Mortal Wkly Rep. 2020;69(3):77-83. Published 2020 Jan 24. doi:10.15585/mmwr.mm6903a5
2. CDC. Child and Adolescent Immunization Schedule by Age. May 2025.
3. CDC. Adult Immunization Schedule by Age. May 2025.
4. Omer SB. Maternal Immunization. N Engl J Med. 2017;376(13):1256-1267. doi:10.1056/NEJMra1509044
Contraindications and Precautions for Tetanus-Diphtheria Vaccine
The main contraindication for Td is:
A severe allergic reaction (eg, anaphylaxis) after a previous dose or to a vaccine component
Precautions with Td include the following:
Guillain-Barré syndrome within 6 weeks after a previous dose of a vaccine that contains TT
Moderate or severe acute illness with or without fever
History of type III hypersensitivity reactions after a previous dose of a vaccine that contains TT or diphtheria toxoid (vaccination is postponed until ≥ 10 years since the last dose of a vaccine that contains TT)
Dose and Administration of Tetanus-Diphtheria Vaccine
The Td dose is 0.5 mL IM.
Booster vaccinations are administered every 10 years.
Adverse Effects of Tetanus-Diphtheria Vaccine
Adverse effects are rare. They include anaphylactic reactions and brachial neuritis.
Mild adverse effects include the following:
Erythema, swelling, and soreness at the injection site
Mild fever
Headache
Fatigue
Nausea, vomiting, diarrhea, or abdominal discomfort
For more information about adverse effects of these vaccines, refer to the prescribing information.
More Information
The following English-language resources may be useful. Please note that The Manual is not responsible for the content of these resources.
Advisory Committee on Immunization Practices (ACIP): ACIP Recommendations: Diphtheria, Tetanus and Pertussis (DTaP/Tdap/Td) Vaccines
ACIP: Changes in the 2025 Child and Adolescent Immunization Schedule
Centers for Disease Control and Prevention (CDC): Diphtheria, Tetanus, and Pertussis
European Centre for Disease Prevention and Control (ECDC): Diphtheria: Recommended vaccinations