For more information, see Tdap/Td ACIP (Advisory Committee on Immunization Practices) Vaccine Recommendations.
The most widely used preparations combine tetanus toxoid with diphtheria toxoid (Td for adults; DT, which contains a higher dose of diphtheria toxoid, for children); a preparation with only tetanus toxoid (TT) is also available but is not recommended because periodic boosting is needed for both antigens. Tdap is an adult preparation that contains a pertussis component (see Diphtheria-Tetanus-Pertussis Vaccine).
Td boosters are given routinely every 10 yr after the Tdap booster is given at age 11 to 12 yr. Patients who have not received or completed a primary vaccination series of at least 3 doses of tetanus and diphtheria vaccine should begin or complete the series.
Patients who have a wound that poses an increased risk of tetanus (see Table: Tetanus Prophylaxis in Routine Wound Management) should be given a Td booster if ≥ 5 yr have elapsed since the previous dose. One dose of Tdap should be substituted for a Td booster if adults have never received Tdap.
The main contraindication is
Guillain-Barré syndrome within 6 wk after a previous dose of a vaccine that contains tetanus toxoid
Moderate or severe acute illness with or without fever
History of type III hypersensitivity reactions after a previous dose of a vaccine that contains tetanus or diphtheria toxoid (vaccination is postponed until ≥ 10 yr since the last dose of a vaccine that contains tetanus toxoid)