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Tetanus-Diphtheria Vaccine

By William D. Surkis, MD, Clinical Associate Professor of Medicine; Director, Internal Medicine Residency Program, Jefferson Medical College; Lankenau Medical Center
Jerome Santoro, MD, Clinical Professor of Medicine; Chief, Department of Medicine, Jefferson Medical College; Lankenau Medical Center

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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.

Contraindications and Precautions

The main contraindication is

  • A severe allergic reaction (eg, anaphylaxis) after a previous dose or to a vaccine component

Precautions include

  • 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)

Dose and Administration

Td 0.5 mL IM is injected into the deltoid with a 22- to 25-gauge needle. Booster vaccinations are given every 10 yr.

Adverse Effects

Adverse effects are very rare. They include anaphylactic reactions and brachial neuritis. Mild effects include erythema, swelling, and soreness at the injection site.