There are four combination vaccines used to prevent diphtheria, tetanus and pertussis: DTaP, Tdap, DT, and Td. Two of these (DTaP and DT) are given to children younger than 7 years of age, and two (Tdap and Td) are given to older children and adults.
Children should get 5 doses of DTaP, one dose at each of the following ages: 2 months, 4 months, 6 months, and 15-18 months and 4-6 years. DT does not contain pertussis vaccine, and is used as a substitute for DTaP for children who cannot tolerate pertussis vaccine.
Td is a tetanus-diphtheria vaccine given to adolescents and adults as a booster shot every 10 years, or after an exposure to tetanus under some circumstances.
Tdap is similar to Td but also contains protection against pertussis. Adolescents 11-18 years of age (preferably at age 11-12 years) and adults 19 and older should receive a single dose of Tdap. Tdap should also be given to 7-10 year olds who are not fully immunized against pertussis. Tdap can be given no matter when Td was last received.
*Upper-case letters in these abbreviations denote full-strength doses of diphtheria (D) and tetanus (T) toxoids and pertussis (P) vaccine. Lower-case “d” and “p” denote reduced doses of diphtheria and pertussis used in the adolescent/adult-formulations. The “a” in DTaP and Tdap stands for “acellular,” meaning that the pertussis component contains only a part of the pertussis organism.
Women should receive Tdap during each of their pregnancies (preferably in the third trimester between the 27th and 36th week).
The Advisory Committee on Immunization Practices guidelines recommend that health care personnel administer a dose of Tdap during each pregnancy, irrespective of the patient’s prior history of receiving Tdap. To maximize the maternal antibody response and passive antibody transfer and levels in the newborn, optimal timing for Tdap administration is between 27 weeks and 36 weeks of gestation, although Tdap may be given at any time during pregnancy. If a Td booster vaccination is indicated during pregnancy (ie, more than 10 years since the previous Td vaccination) then health care providers should administer Tdap during pregnancy, preferably between 27 weeks and 36 weeks of gestation. Because of the nonurgent nature of this indication, waiting until 27–36 weeks of gestation appears to be the appropriate management plan to obtain maternal immunity and maximize antibody transfer to the newborn. For women who previously have not received Tdap, if Tdap was not administered during pregnancy it should be administered immediately postpartum to the mother in order to reduce the risk of transmission to the newborn.
It is safe to administer Tdap to breastfeeding women.
Cocoonning: Adolescents and Adults in contact with infants
It is recommended that all adolescents and adults who have or who anticipate having close contact with an infant younger than 12 months (eg, siblings, parents, grandparents, child care providers, and health care providers) who previously have not received Tdap should receive a single dose of Tdap to protect against pertussis and reduce the likelihood of transmission. Ideally, these adolescents and adults should receive Tdap at least 2 weeks before they have close contact with the infant.
CDC and the Food and Drug Administration (FDA) closely monitor the safety of diphtheria, tetanus, and pertussis vaccines. Problems detected with these vaccines will be reported to health officials, health care providers, and the public. Needed action will be taken to ensure the public’s health and safety.