Answers to Common Questions About Tdap Vaccine

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Can Tdap be given to adolescents who received Td previously?
Do the same precautions that apply to DTaP also apply to Tdap?
If a child 7-9 years of age has no record of DTaP immunization, can a dose of Tdap be given as part of the primary series?
If patients have a history of pertussis disease, should they receive Tdap?
Can Tdap, instead of Td, be given as part of wound management?
Should Tdap be given every 10 years?
What if Tdap is mistakenly given to an adult over age 65 or a child 7-9 years?
What schedule should be used to vaccinate adolescents or adults who never received the primary series of tetanus toxoid-containing vaccine?
What about simultaneous and nonsimultaneous vaccination of other vaccines a patient might need?

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Can Tdap be given to adolescents who received Td previously?
Yes. Any adolescent ages 11-18 years who received a dose of Td (but not Tdap) is encouraged to receive a single dose of Tdap to provide protection against pertussis. A 5-year interval is encouraged to reduce the risk of a local adverse reaction. However, if pertussis immunity is needed, an interval of less than 5 years may be used. The recipient should be advised about the increased risk of a local reaction and given instructions on what to do should this occur.

Do the same precautions that apply to DTaP also apply to Tdap?
No, many of the precautions to DTaP--including temperature of 105° F or higher, collapse or shock-like state, persistent crying lasting 3 hours or longer, convulsions with or without fever--do not apply to Tdap. Precautions to Tdap include a progressive neurologic disorder and history of Guillain Barre Syndrome following a previous dose of Td. A complete discussion of contraindications and precautions are in the Tdap Advisory Committee on Immunization Practices (ACIP), recommendations are available at www.cdc.gov/mmwr/pdf/rr/rr5503.pdf.

If a child 7-9 years of age has no record of DTaP immunization, can a dose of Tdap be given as part of the primary series?
No. Tdap is not approved for children ages 7-9 years. Children in this age group should receive a series of 3 doses of Td. They can then be boosted with Tdap 5 years after they complete the series. If a child reaches age 10 years before completing the primary 3-dose Td series, a dose of Tdap should replace one of the doses.

If patients have a history of pertussis disease, should they receive Tdap?
Yes. Generally, persons needing Tdap should receive it regardless of a history of pertussis disease. However, if pertussis disease was recent (less than 5 years) and the diagnosis was certain (i.e., culture-confirmed, or epi-linked to a culture -confirmed case), it is reasonable to wait 3-5 years before administration of Tdap, unless tetanus and diphtheria toxoids are needed.

Can Tdap, instead of Td, be given as part of wound management?
Yes, if the vaccinee is 10-64 years of age and has not received Tdap previously.

Should Tdap be given every 10 years?
The vaccine is licensed for just 1 dose . Subsequent doses, as well as vaccine given to adults ages 65 years and older, should be Td.

What if Tdap is mistakenly given to an adult over age 65 or a child 7-9 years?
Use of Tdap in persons 65 years or older or in children ages 7-9 is considered off-label and is not recommended. However, the dose can be counted and does not need to be repeated with Td.

What schedule should be used to vaccinate adolescents or adults who never received the primary series of tetanus toxoid-containing vaccine?
Persons 10-64 years of age who have never received tetanus-containing vaccines, or whose vaccination history is unknown, should receive 1 dose of Tdap in the primary 3-dose Td series. ACIP recommends using Tdap for dose #1, followed 4 weeks later by Td for dose #2, followed at least 6 months later by Td for dose #3. Tdap may be given as any of the doses if the series has already been started. The amount of protection provided by a single dose of Tdap in a person who has not previously received pertussis vaccine is not known.

What about simultaneous and nonsimultaneous vaccination of other vaccines a patient might need?
Tdap should be administered simultaneously with other vaccines that are indicated during the same visit when feasible. Each vaccine should be administered using a separate syringe at a different anatomic site.

If simultaneous vaccination is not feasible, inactivated vaccines like Tdap can be administered at any time before or after other inactivated or live vaccines. Tdap and MCV4 vaccines (which both contain diphtheria toxoid) can be administered using any sequence. Note that persons who recently received one diphtheria toxoid-containing vaccine might have increased rates of adverse reactions after a subsequent diphtheria toxoid-containing vaccine when diphtheria antibody titers remain elevated from the previous vaccination.