Tetanus-Diphtheria Vaccine

The most widely used preparations combine tetanus toxoidTdap) is an adolescent and adult preparation that contains a pertussis component.

Tetanus-diphtheria (Td) or Tdap boosters are given routinely every 10 years after the Tdap booster is given 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 should begin or complete the series. (See Centers for Disease Control and Prevention (CDC) Child and Adolescent Immunization Schedule by Age and Adult Immunization Schedule by Age.)

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.

Pregnant women 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.

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

• Guillain-Barré syndrome within 6 weeks after a previous dose of a vaccine that contains tetanus toxoid

• Moderate or severe acute illness with or without fever

• History of type III hypersensitivity reactions after a previous dose of a vaccine that contains tetanus or diphtheria toxoid (vaccination is postponed until ≥ 10 years since the last dose of a vaccine that contains tetanus toxoid)

The Td dose is 0.5 mL IM. Booster vaccinations are given every 10 years.

Adverse effects are very rare. They include anaphylactic reactions and brachial neuritis. Mild effects include erythema, swelling, and soreness at the injection site.

The following English-language resources may be useful. Please note that THE MANUAL is not responsible for the content of these resources.

1. Advisory Committee on Immunization Practices (ACIP): DTaP/Tdap/Td ACIP Vaccine Recommendations

2. Centers for Disease Control and Prevention (CDC): Diphtheria, Tetanus, and Pertussis Vaccination: Information for Healthcare Professionals

3. European Centre for Disease Prevention and Control (ECDC): Diphtheria: Recommended vaccinations

4. European Centre for Disease Prevention and Control (ECDC): Tetanus: Recommended vaccinations