Tetanus, diphtheria and pertussis vaccines in adolescents and adults (Tdap and Td)

The disease and why it matters

Tdap and Td protect against tetanus and diphtheria; Tdap also protects against pertussis. Tetanus enters the body through cuts or wounds and causes painful stiffening of the muscles, which can lead to being unable to open the mouth, trouble swallowing and breathing, or death. ^[1]

Diphtheria can lead to difficulty breathing, heart failure, paralysis or death, and diphtheria and pertussis spread from person to person. ^[1]

Pertussis (whooping cough) can cause uncontrollable, violent coughing that makes it hard to breathe, eat or drink; it is most serious in babies and young children, and in teens and adults it can cause weight loss, loss of bladder control, passing out and rib fractures from severe coughing. ^[1]

The Pink Book notes that infants younger than 1 year continue to have the highest rates of pertussis, that waning of vaccine-induced immunity is thought to play a key role in the United States since the transition to acellular vaccines in the 1990s, and that adolescents and adults may develop complications including difficulty sleeping, urinary incontinence, pneumonia, rib fracture, syncope and weight loss. ^[2]

CDC describes tetanus as an uncommon but serious infection caused by bacteria found in the environment, and says the best way to prevent it is to get vaccinated. ^[3]

Video and figures

Video

The video loads from YouTube when played.

What is Pertussis and whooping cough? - Bordetella pertussis symptoms, pathophysiology and treatment
Channel: Armando Hasudungan · Uploaded January 2, 2024 · Confirmed available October 12, 2026 · Open on YouTubeRxEvidence has not checked every statement in this video.

Get CE credit

Products available

The United States uses three combination vaccines that include tetanus protection: DTaP, Tdap and Td. DTaP and Tdap also protect against diphtheria and pertussis; Td also protects against diphtheria; DT is no longer available. Children younger than 7 years receive DTaP, while older children and adults receive Tdap or Td. This lesson covers Tdap and Td. ^[3]

CDC reports that DTaP and Tdap contain pertussis antigen but Td does not; for patients with a contraindication specific to pertussis-containing vaccines, persons 7 years or older should receive Td instead of Tdap. ^[3]

Who should get it

CDC's pertussis page recommends a single dose of Tdap for adults who have never received Tdap, given at any time regardless of when they last got Td; there is no recommendation for pertussis booster doses to maintain protection, even though immunity wanes after a few years, but adults do need booster doses every 10 years against tetanus and diphtheria, for which providers can give Td or Tdap. ^[14]

Adolescents: CDC recommends a single dose of Tdap at 11 to 12 years of age. Pregnancy: CDC recommends a single dose of Tdap during every pregnancy, preferably during the early part of gestational weeks 27 through 36, and recommends Tdap postpartum only for women who have never received Tdap; women who received Tdap previously but were not vaccinated during pregnancy should not receive a postpartum dose. ^[14]

Healthcare personnel should follow the same immunization guidance as all adults. ^[14]

Age 65 and older: CDC says to administer Boostrix when feasible, because Adacel is approved only up through 64 years of age, but providers should not miss an opportunity to vaccinate adults 65 or older and may give whichever Tdap they have, which will be valid. This is a difference between the Adacel label and CDC guidance. ^{[14] [4] [6]}

The labels give booster intervals that differ from the every-10-years routine: Adacel is given 5 years or more after the last DTaP series dose or Td dose, with a second Adacel dose 8 years or more after the first; Boostrix is given 5 years or more after the last DTaP series dose or Td dose, with an additional Boostrix dose 9 years or more after the initial dose. ^{[4] [6]}

Dosing and schedule, including catch-up

CDC's wound guidance: vaccination is recommended for all wounds in people with an unknown vaccination history, who are unvaccinated, or who have an incomplete primary series; for clean and minor wounds in people with a complete primary series whose last dose was 10 or more years ago; and for dirty or major wounds in people with a complete primary series whose last dose was 5 or more years ago. No tetanus vaccination is needed regardless of wound type if the last dose was less than 5 years ago and the primary series is complete. ^[15]

Tdap is preferred for persons who have not previously received Tdap or whose Tdap history is unknown; if a tetanus-toxoid-containing vaccine is indicated for a pregnant woman, use Tdap. ^[12]

Tetanus immune globulin (TIG): for clean and minor wounds TIG is never indicated; for dirty or major wounds it is indicated for people with an unknown or incomplete tetanus vaccination history, people who have never received tetanus vaccine, people with HIV and people with a severe immunodeficiency, at 250 international units intramuscularly. CDC does not stockpile or supply TIG; it is commercially available. Antibiotics are not recommended to prevent tetanus. ^[15]

Catch-up in adolescents and children: CDC recommends routine Tdap for adolescents at 11 to 12 years and publishes job aids for catch-up of children who start late; those details are in CDC's child and adolescent schedule and are not reproduced here. ^[3]

The Tenivac label describes primary immunization of 3 doses (the first 2 doses 2 months apart and the third 6 to 8 months after the second) and routine booster immunization at 11 to 12 years and every 10 years thereafter; a booster may be given for post-exposure diphtheria prophylaxis or tetanus-prone wound management if at least 5 years have elapsed. ^[8]

Administration

All four vaccines are given intramuscularly as a 0.5 mL dose; Adacel, Boostrix and Tenivac are injectable suspensions. ^{[4] [6] [8]}

Tdap and Td may be given at the same time as other vaccines. ^{[1] [16]}

Syncope can occur with injectable vaccines, including Adacel and Tenivac; procedures should be in place to avoid injury from fainting. ^{[4] [8]}

Storage and handling

Latex: the Tenivac prefilled syringe tip caps may contain natural rubber latex, while the Tenivac vial contains no latex; the Boostrix vial stoppers and prefilled syringe tip cap and plunger stopper, and the Adacel syringe and vial stopper, are not made with natural rubber latex. ^{[8] [6] [4]}

Contraindications and precautions

• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component is a contraindication for Tdap and Td in CDC's adult appendix. ^[17]
• For Tdap only, encephalopathy (e.g., coma, decreased level of consciousness, prolonged seizures) not attributable to another cause within 7 days of a previous dose of DTP, DTaP or Tdap is a contraindication. ^{[17] [4] [6]}
• Precautions in CDC's appendix include Guillain-Barré syndrome within 6 weeks after a previous dose of a tetanus-toxoid-containing vaccine, and a history of Arthus-type hypersensitivity after a previous dose of a diphtheria- or tetanus-toxoid-containing vaccine (defer until at least 10 years have elapsed since the last tetanus-toxoid-containing vaccine). ^[17]
• The Adacel label states that progressive or unstable neurologic conditions are reasons to defer Adacel vaccination, and the Boostrix label that they are reasons to defer vaccination with a pertussis-containing vaccine. ^{[4] [6]}
• The Tenivac and TdVax labels state that more frequent administration than described may be associated with increased incidence and severity of adverse reactions, and that people who had an Arthus-type reaction should not receive them more often than every 10 years, even for tetanus prophylaxis as part of wound management. ^{[8] [10]}
• People with minor illnesses such as a cold may be vaccinated; people who are moderately or severely ill should usually wait until they recover. ^[16]

Safety and adverse events

Guillain-Barré syndrome: if it occurred within 6 weeks of a prior dose of a tetanus-toxoid-containing vaccine, the risk may be increased following a subsequent dose, according to the Adacel and Boostrix labels; the TdVax label notes that an Institute of Medicine review found evidence of a causal relation between tetanus toxoid and Guillain-Barré syndrome. ^{[4] [6] [10]}

CDC's Td VIS lists pain, redness or swelling where the shot was given, mild fever, headache, feeling tired, and nausea, vomiting, diarrhea or stomachache as sometimes happening after Td vaccination, and notes that people sometimes faint after vaccination. ^[16]

Special populations

Pregnancy: the Adacel and Boostrix labels include immunization during the third trimester of pregnancy to prevent pertussis in infants younger than 2 months, while CDC specifies a dose during every pregnancy, preferably in the early part of gestational weeks 27 through 36. ^{[4] [6] [14]}

The Boostrix label advises women who receive Boostrix during pregnancy to enroll in the pregnancy registry. ^[6]

Older adults: the Tenivac label reports lower pre- and post-vaccination tetanus and diphtheria seroprotection rates in participants 65 years and older than in younger participants, with solicited reaction rates not generally higher. ^[8]

Pediatric patients: Tdap and Td are for children 7 years and older, adolescents and adults; children younger than 7 years receive DTaP. ^{[1] [3]}

Immunocompromised patients: the TdVax label notes that if it is given to immunocompromised persons (from disease or treatment) the expected immune response may not be obtained. ^[10]

Counseling pearls for the pharmacy counter

• Tell the vaccination provider about an allergic reaction after any vaccine that protects against tetanus, diphtheria or pertussis, or any severe, life-threatening allergy. ^[1]
• Tell the provider about coma, decreased level of consciousness or prolonged seizures within 7 days after a previous dose of any pertussis vaccine, or about seizures. ^[1]
• Adults should receive a booster of Td or Tdap every 10 years, or after 5 years in the case of a severe or dirty wound or burn. ^[1]
• Pregnant women should get a dose of Tdap during every pregnancy to help protect the newborn from pertussis, because infants are most at risk for severe, life-threatening complications. ^[1]
• Ask about severe pain or swelling after a previous dose of any tetanus- or diphtheria-containing vaccine and about prior Guillain-Barré syndrome. ^[16]

Common patient questions

References

1. Centers for Disease Control and Prevention. Tdap (tetanus, diphtheria, pertussis) vaccine: what you need to know. Vaccine Information Statement, January 31, 2025. Accessed October 11, 2026. https://www.cdc.gov/vaccines/hcp/current-vis/tdap.html. Accessed October 11, 2026.
2. Centers for Disease Control and Prevention. Pertussis. In: Epidemiology and Prevention of Vaccine-Preventable Diseases (Pink Book), web chapter. Accessed October 11, 2026. https://www.cdc.gov/pinkbook/hcp/table-of-contents/chapter-16-pertussis.html. Accessed October 11, 2026.
3. Centers for Disease Control and Prevention. Tetanus vaccine recommendations: information for healthcare professionals. Page dated September 10, 2026. Accessed October 11, 2026. https://www.cdc.gov/vaccines/vpd/dtap-tdap-td/hcp/recommendations.html. Accessed October 11, 2026.
4. Adacel (tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine adsorbed), injectable suspension for intramuscular use: prescribing information. Sanofi Pasteur; revised 8/2026. U.S. Food and Drug Administration. Accessed October 11, 2026. https://www.fda.gov/media/119862/download?attachment. Accessed October 11, 2026.
5. U.S. Food and Drug Administration. Adacel (STN BL 125111), product page (content current as of 08/27/2026). Accessed October 11, 2026. https://www.fda.gov/vaccines-blood-biologics/vaccines/adacel. Accessed October 11, 2026.
6. BOOSTRIX (tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine, adsorbed) injectable suspension, for intramuscular use: prescribing information. GlaxoSmithKline Biologicals; revised 5/2026. U.S. Food and Drug Administration. Accessed October 11, 2026. https://www.fda.gov/media/124002/download?attachment. Accessed October 11, 2026.
7. U.S. Food and Drug Administration. BOOSTRIX (STN BL 125106), product page (content current as of 05/15/2026). Accessed October 11, 2026. https://www.fda.gov/vaccines-blood-biologics/vaccines/boostrix. Accessed October 11, 2026.
8. TENIVAC (tetanus and diphtheria toxoids adsorbed) injectable suspension, for intramuscular use: prescribing information. Sanofi Pasteur; revision date shown as "x/2026". U.S. Food and Drug Administration. Accessed October 11, 2026. https://www.fda.gov/media/76610/download?attachment. Accessed October 11, 2026.
9. U.S. Food and Drug Administration. TENIVAC product page (content current as of 08/27/2026). Accessed October 11, 2026. https://www.fda.gov/vaccines-blood-biologics/vaccines/tenivac. Accessed October 11, 2026.
10. TDVAX (tetanus and diphtheria toxoids adsorbed): prescribing information. MassBiologics. U.S. Food and Drug Administration. Accessed October 11, 2026. https://www.fda.gov/media/76430/download?attachment. Accessed October 11, 2026.
11. U.S. Food and Drug Administration. TDVAX product page (content current as of 11/16/2018). Accessed October 11, 2026. https://www.fda.gov/vaccines-blood-biologics/vaccines/tdvax. Accessed October 11, 2026.
12. Centers for Disease Control and Prevention. Adult immunization schedule notes: recommendations for ages 19 years or older, United States, 2025. July 2, 2025. Accessed October 11, 2026. https://www.cdc.gov/vaccines/hcp/imz-schedules/adult-notes.html. Accessed October 11, 2026.
13. American Academy of Family Physicians. Adults 19 and older immunization schedules (adopted version; page shows no version date). Accessed October 11, 2026. https://www.aafp.org/clinical-insights/immunizations-and-vaccines/immunizations-schedules-resources/adult-immunization-schedules. Accessed October 11, 2026.
14. Centers for Disease Control and Prevention. Pertussis vaccination recommendations: information for healthcare professionals. Page dated December 2, 2025. Accessed October 11, 2026. https://www.cdc.gov/pertussis/hcp/vaccine-recommendations/index.html. Accessed October 11, 2026.
15. Centers for Disease Control and Prevention. Clinical guidance for wound management to prevent tetanus. Page dated September 8, 2026. Accessed October 11, 2026. https://www.cdc.gov/tetanus/hcp/clinical-guidance/index.html. Accessed October 11, 2026.
16. Centers for Disease Control and Prevention. Td (tetanus, diphtheria) vaccine: what you need to know. Vaccine Information Statement, August 6, 2021. Accessed October 11, 2026. https://www.cdc.gov/vaccines/hcp/current-vis/td.html. Accessed October 11, 2026.
17. Centers for Disease Control and Prevention. Adult immunization schedule appendix: guide to contraindications and precautions, United States, 2025. July 2, 2025. Accessed October 11, 2026. https://www.cdc.gov/vaccines/hcp/imz-schedules/adult-appendix.html. Accessed October 11, 2026.