VACCINE TYPE

  • Types/abbreviations:
    • DT (tetanus + diphtheria toxoids)
    • Td (tetanus toxoid+ reduced-dose diphtheria toxoid)
    • DTaP (DT + acellular pertussis)
    • Tdap (Td + reduced-dose acellular pertussis)
  • Usual administrations:
    • DTaP and DT: are given to children < 7 y/o
    • Tdap and Td: are given to older children and adults
    • For other combinations, see formulations

INDICATIONS

ACIP RECOMMENDATIONS

  • Children (birth to 18 y/o) [1]:
    • All children should receive 5 doses of DTaP as a primary series
      • 1 dose at each of the following ages: 2, 4, 6, and 15-18 months and 4-6 years.
    • All adolescent between ages of 11 and 12 should receive a single dose of Tdap.
      • This can be administered regardless of the timing of the last TD containing vaccine administration.
    • Pregnant adolescents: Tdap during each pregnancy (preferably between the 27th and 36th week) [6].
    • Catch-up immunizations:
      • Children (>7 y/o) should receive 5 doses of DTaP during the catch-up months.
        • Doses 1-3 doses should be given 4 weeks apart, dose 4 should be given 6 months after dose 3, followed by dose 5, 6 months later.
        • For more information see ACIP immunization schedule
      • Children (7-10 y/o) who are not fully vaccinated with DTaP should receive a single dose of Tdap (preferably the first dose in the catch-up series).
        • An additional dose of Tdap should NOT be administered at age 11-12.
        • Td should be administered instead 10 years after the Tdap dose.
      • Adolescent (11-18 y/o): if never having received Tdap vaccine, should receive a single dose of Tdap, followed by Td booster doses every 10 years thereafter.
      • Inadvertent doses of DTaP vaccine, see ACIP immunization schedule.
  • Adults (≥19 y/o) [2]:
    • Unvaccinated individuals: complete primary Td series (3 doses) with Td.
    • Boosters:
      • All adults, to receive single dose of Tdap.
        • This can be administered regardless of the timing of the last Td administration.
      • Td booster every 10 years
    • Pregnant women: all to get a Tdap during EACH pregnancy (preferably between the 27th and 36th week) [6].
    • All health-care workers should receive Tdap independent of their previous Td dose [4].

OTHER INFORMATION

  • Travelers: give booster (Td or Tdap, depending) if diphtheria acquisition risk high.

FORMS

brand name

preparation

manufacturer

route

form

dosage^

cost*

ADACEL

Tetanus toxoid, reduced Diphtheria toxoid, and acellular Pertussis vaccine adsorbed (Tdap)

Sanofipasteur

IM

vial, syringe

2-5-2.5/0.5 mL

$51.65

BOOSTRIX

Tetanus toxoid, reduced Diphtheria toxoid, and acellular Pertussis vaccine adsorbed (Tdap)

GlaxoSmithKline

IM

vial, syringe

2.5-5-8/0.5 mL

$45.88

DAPTACEL

Diphtheria and Tetanustoxoids, and acellular Pertussis vaccine adsorbed (DTaP)

Sanofipasteur

IM

vial

15-5-10/0.5 mL

$67.29

Td (generic)

Diphtheria and Tetanustoxoids (Td)

Grifols USA LLC

IM

vial

2-2 LF/0.5 mL

$26.34

DT

Diphtheria and Tetanustoxoids (DT)

Sanofipasteur

IM

vial

5-25/0.5 mL

$113

INFARIX

Diphtheria and Tetanustoxoids and acellular Pertussis vaccine adsorbed (DTaP)

GlaxoSmithKline

IM

vial, syringe

25-10-25/0.5 mL

$26

KINRIX

Diphtheria and Tetanustoxoids, and acellular Pertussis adsorbed and inactivated Poliovirus vaccine (DTaP-IPV)

GlaxoSmithKline

IM

vial, syringe

25-10-25/0.5 mL

$58.62

PEDIARIX

Diphtheria and Tetanustoxoids and acellular Pertussis adsorbed, Hepatitis B (recombinant) and inactivated Poliovirus vaccine (DTaP-HBV-IPV)

GlaxoSmithKline

IM

syringe

25-10-25/0.5 mL

$68.47

PENTACEL

Diphtheria and Tetanustoxoids, and acellular Pertussis adsorbed, and inactivated Poliovirus vaccine, and Haemophilus b conjugate vaccine (DTaP-IPV-Hib)

Sanofipasteur

IM

KIT

15-20-5-10

$105

TENIVAC

Tetanus and Diphtheria toxoids adsorbed (Td)

Sanofipasteur

IM

vial, syringe

2-5/0.5 mL

$70.8

QUADRACEL

Diphtheria and Tetanustoxoids, and acellular Pertussis adsorbed and inactivated Poliovirus vaccine (DTaP-IPV)

Sanofipasteur

IM

vial

15-25-20/0.5 mL

N/A

*Prices represent cost per unit specified, are representative of "Average Wholesale Price" (AWP).
^Dosage is indicated in mg unless otherwise noted.

PATHOGEN DIRECTED PROTECTION

Corynebacterium diphtheriae, Diptheria

DOSE/ADMINISTRATION

Adult PRIMARY SERIES

  • ADACEL, BOOSTRIX (adult Tdap): one dose of 0.5 mL IM.
  • TENIVAC (adult Td): three doses of 0.5 mL IM.
    • Dose 1 and 2 should be separated by 1-2 months.
    • Dose 2 and 3 should be separated by 6-12 months.
    • One-time dose of Tdap can be substituted for one of the doses in the series, preferably the first.

Adult BOOSTER

  • 0.5 mL Td booster every 10 years.
    • Tdap should replace Td for adults without prior Tdap dose.

Pediatric PRIMARY SERIES

  • INFANRIX (DTaP) or DAPTACEL (DTaP):
    • 0.5 mL IM (x 5 doses) 2, 4, and 6 months of age, followed by 2 booster doses, administered at 15 to 18 months of age and at 4 to 6 years of age.
    • For children in whom pertussis vaccine is contraindicated:
      • DT (pediatric DT), starting at 6 weeks administer three doses of 0.5 mL IM 4 to 8 weeks apart, then a another dose is given 6 to 12 months after the third injection.
  • PEDIARIX (DTaP +HepB vaccine+ Inactivated Poliovirus Vaccine): 3 doses of 0.5 mL IM at 8-week intervals starting at 2 months of age.

Pediatric BOOSTER

  • INFANRIX (DTaP) or DAPTACEL (DTaP): 0.5 mL IM. As noted above, doses 3 (at 15-18 months of age) and 4 (at 4-6 years of age) are booster doses.
  • Tdap (Boostric or Adacel) 0.5mL IM booster routinely given at age 11-12 years (minimum age: 10 years).
    • 0.5 mL Td booster every 10 years after the Tdap booster at age 11-12 years.

ADVERSE DRUG REACTIONS

GENERAL

  • Generally well tolerated.

COMMON

  • Pain and tenderness at injection site; rate increases with more doses.

RARE

  • Anaphylaxis
  • Encephalopathy
  • Arthralgia
  • Fever
  • Guillain-Barre syndrome
  • Arthus reaction (severe pain, swelling, induration, edema, hemorrhage, and occasional local necrosis)

VACCINE/DRUG INTERACTIONS

  • The simultaneous administration of DT, MMR, OPV, or inactivated poliovirus vaccine (IPV), and Haemophilus b Conjugate Vaccine (HbCV) is acceptable.
  • Immunosuppressive therapies, including irradiation, antimetabolites, alkylating agents, cytotoxic drugs, and corticosteroids (used in greater than physiologic doses), may reduce the immune response to vaccines.

CONTRAINDICATIONS

  • History of anaphylaxis to vaccine components.
  • Encephalopathy within 7 days of administration of pertussis vaccine should not receive Tdap.
  • Use with caution with history of Guillain-Barre syndrome (within 6 weeks after previous tetanus toxoid-containing vaccine), moderate or acute severe illness, unstable neurological conditions, and Arthus hypersensitivity reaction.

IMMUNE RESPONSE

  • Response usually good, but reduced in elderly.
  • Anti-diphtheria response: 99.9% had seroprotective anti-diphtheria levels >0.1 IU/mL and booster response was 91-96%.

CLINICAL EFFICACY

  • Clinical efficacy of ~ 97%
  • < 5 diphtheria cases have been reported in U.S. since 2000.

OTHER INFORMATION

  • Td preferred for adults (less local reactions) and during pregnancy
  • DT: Pediatric preparation, contraindicated in persons >7 yrs.

Basis for recommendation

  1. Diphtheria, tetanus, and pertussis: recommendations for vaccine use and other preventive measures. Recommendations of the Immunization Practices Advisory committee (ACIP). MMWR Recomm Rep 40:1, 1991  [PMID:1865873]

    Comment: ACIP recommendations for diphtheria, tetanus, and pertussis vaccine recommendations.

  2. Kim DK et al: Advisory Committee on Immunization Practices Recommended Immunization Schedule for Adults Aged 19 Years or Older - United States, 2016. MMWR Morb Mortal Wkly Rep 65:88, 2016  [PMID:26845417]

    Comment: Updated (2015) ACIP immunization schedule for adults ≥ 19 y/o.

  3. Kretsinger K et al: Preventing tetanus, diphtheria, and pertussis among adults: use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine recommendations of the Advisory Committee on Immunization Practices (ACIP) and recommendation of ACIP, supported by the Healthcare Infection Control Practices Advisory Committee (HICPAC), for use of Tdap among health-care personnel. MMWR Recomm Rep 55:1, 2006  [PMID:17167397]

    Comment: The ACIP recommendations for 2006 were changed to include Tdap as a one time single dose vaccine for persons <65 yrs.

References

  1. Advisory Committee on Immunization Practices, Centers for Disease Control and Prevention (CDC): Immunization of health-care personnel: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 60:1, 2011  [PMID:22108587]

    Comment: ACIP recommends that all healthcare workers should receive a single dose of Tdap regardless of the time since their most recent Td vaccination.
    Rating: Important

  2. Centers for Disease Control and Prevention (CDC): Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine in adults aged 65 years and older - Advisory Committee on Immunization Practices (ACIP), 2012. MMWR Morb Mortal Wkly Rep 61:468, 2012  [PMID:22739778]

    Comment: In 2012 ACIP updated its recommendations to include recommendation to vaccinate all adults ³ 65 y/o with Tdap vaccine. In 2011, FDA approved expanding the age indication for Boostrix to aged 65 years and older. This recommendation supersedes previous recommendation about Tdap vaccination in adults 65 y/o.
    Rating: Important

  3. Centers for Disease Control and Prevention (CDC): Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) in pregnant women--Advisory Committee on Immunization Practices (ACIP), 2012. MMWR Morb Mortal Wkly Rep 62:131, 2013  [PMID:23425962]

    Comment: 2012 ACIP updated recommendations: Tdap is now recommended during every pregnancy to reduce the burden of pertussis in infants.
    Rating: Important

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Last updated: July 1, 2016