Tetanus, Diphtheria, and Pertussis (Tdap) Vaccine

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On this page:
Off-label use of Tdap products
Available licensed Tdap products
Tdap vaccination recommendations
Children (7-10 years):
Adolescents (11-18 years)
Adults (19-64 years)
Persons over 64 years of age
Wound management
Health care workers
Pregnant women
Future for Tdap

In 2005, two tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine, adsorbed (Tdap) products were licensed. These products are the first pertussis vaccines formulated for use in adolescents and adults in the United States. Pertussis vaccination is important for these groups because immunity against pertussis wanes five to 10 years after the last childhood DTaP vaccination, which is typically administered at 4-6 years of age.

Off-label use of Tdap products

Tdap is currently licensed and recommended as a one-time single dose. However, ACIP has recommended off-label use of Tdap products in order to expand Tdap vaccination and reduce pertussis disease.

Off-label use includes administering Tdap:

Boostrix or Adacel to persons age 7-10 years who either have not completed their DTaP primary series, or who have not received a primary series of tetanus, pertussis, and diphtheria, or if their vaccination status is unknown.
Regardless of the interval since last Td dose.
Adacel to persons 65 years and older who care for or will care for children under age 1 year.
Adacel to anyone age 65 years or older.

Note: Boostrix is licensed for use as a one-time dose in persons age 65 years and older.

Available licensed Tdap products

Adacel, manufactured by sanofi pasteur and licensed for persons age 11-64 years.
Boostrix, manufactured by GlaxoSmithKline and licensed for persons age 10-64 years.

Tdap vaccination recommendations

Children (7-10 years):

Give to incompletely vaccinated children for whom no pertussis contraindication exists.
Give one Tdap as part of a three-dose primary series to those who have never been vaccinated against diphtheria, tetanus, and pertussis, or whose vaccination status is unknown.

Adolescents (11-18 years):

Give routinely at the 11-12 year old visit in place of a Td booster.
Give to persons age 13-18 years who have not yet received a Td booster.
In settings where pertussis is circulating, consider giving Tdap regardless of the interval since the last Td.

Adults (19-64 years):

Give a single dose of Tdap in place of the Td booster if the Td was received 10 or more years earlier.
Give a single dose of Tdap, regardless of when the last Td was given, to those who have or anticipate having close contact with an infant younger than 1 year of age (e.g., parents, child care providers, health care providers).

Persons over 64 years of age:

Give Tdap to persons who have or will have close contact with an infant under age 1 year.
A Tdap may be given to any person age 65 years or older regardless of the interval since the last Td.

Wound management:

If tetanus prophylaxis is indicated, use Tdap as licensed for persons 10 through 64 years, unless the person has received a prior dose of Tdap.

Health care workers:

Health care workers who work in hospitals or ambulatory (acute) care settings and have direct patient contact should receive a single dose of Tdap as soon as feasible.
Give Tdap, regardless of when the last Td was given.
Priority should be given to those caring for infants younger than 1 year of age.
Hospitals and acute ambulatory facilities should provide Tdap for health care workers.

Pregnant women:

Women who have not previously received a dose of Tdap should be vaccinated in the late second* or third trimester. This includes women who are due for a booster.
Pregnant women who have not received the three-dose primary tetanus vaccination series should begin this series during pregnancy, using Td and should receive one of the three doses as Tdap, preferably in the late second* or third trimester.

* After 20 weeks gestation.