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Diphtheria-Tetanus-Pertussis Vaccine


Margot L. Savoy

, MD, MPH, Lewis Katz School of Medicine at Temple University

Reviewed/Revised Jul 2023

Preparations of Diphtheria-Tetanus-Pertussis Vaccine

Diphtheria (D) vaccines contain toxoids prepared from Corynebacterium diphtheriae. Tetanus (T) vaccines contain toxoids prepared from Clostridium tetani. Acellular (a) pertussis (P) vaccines contain semipurified or purified components of Bordetella pertussis. Whole-cell pertussis vaccine is no longer available in the United States because of concerns about adverse effects, but it is still available in other parts of the world. There are 2 preparations of the diphtheria/tetanus toxoids/pertussis vaccine:

  • Diphtheria-tetanus-acellular pertussis (DTaP) for children < 7 years

  • Tetanus-diphtheria-pertussis (Tdap) for adolescents and adults

Tdap contains lower doses of diphtheria and pertussis components (indicated by the lower case d and p).

Indications for Diphtheria-Tetanus-Pertussis Vaccine

DTaP is a routine childhood vaccination (see CDC: Child and Adolescent Immunization Schedule by Age).

Additional boosters of Tdap are also recommended for

  • Pregnant women during each pregnancy (preferably at 27 to 36 weeks gestation), regardless of the interval since any previous dose of Tdap

  • Postpartum women who have never received Tdap

Adults who require a tetanus toxoid-containing vaccine as part of wound management and who have not previously received Tdap are given Tdap instead of tetanus-diphtheria (Td). Those who have previously received Tdap may be given Tdap or Td.

People who have had pertussis should still receive a pertussis-containing vaccine as per routine recommendations.

Contraindications and Precautions for Diphtheria-Tetanus-Pertussis Vaccine

Contraindications for DTaP and Tdap are

Because tetanus vaccination is important, people who have had an anaphylactic reaction to components in DTaP or Tdap should be referred to an allergist to determine whether they are allergic to tetanus toxoid. If not, they can be vaccinated with tetanus toxoid (TT) vaccine. Adults with a history of encephalopathy can be vaccinated with tetanus-diphtheria, and children can be given diphtheria-tetanus (DT) instead of Tdap.

Precautions vary depending on the formulation.

For DTaP and Tdap, they include

For DTaP only, precautions include

  • A seizure, with or without fever, within 3 days after a previous dose of DTaP

  • ≥ 3 hours of persistent, severe, inconsolable screaming or crying within 48 hours after a previous dose of DTaP

  • Collapse or shock-like state (hypotonic hyporesponsive episode) within 48 hours after a previous dose of DTaP

  • Temperature of ≥ 40.5° C, unexplained by another cause, within 48 hours after a previous dose of DTaP

For Tdap only, precautions include

Dose and Administration of Diphtheria-Tetanus-Pertussis Vaccine

The dose for DTaP or Tdap is 0.5 mL IM.

The DTaP vaccine is given as 5 primary and 1 booster IM injections during childhood as follows: at age 2 months, 4 months, 6 months, 15 to 18 months, and 4 to 6 years (before school entry). The fifth dose is not necessary if the fourth dose was given at age ≥ 4 years and at least 6 months after the third dose.

A single booster of Tdap is given, except for pregnant women, who should have a dose during each pregnancy, preferably at 27 to 36 weeks gestation.

Pearls & Pitfalls

  • Pregnant women should have a booster dose of Tdap during each pregnancy.

Adverse Effects of Diphtheria-Tetanus-Pertussis Vaccine

Adverse effects are rare and are mostly attributable to the pertussis component. They include the following:

  • Encephalopathy within 7 days

  • A seizure, with or without fever, within 3 days

  • ≥ 3 hours of persistent, severe, inconsolable screaming or crying within 48 hours

  • Collapse or shock within 48 hours

  • Temperature of 40.5° C, unexplained by another cause, within 48 hours

  • Immediate severe or anaphylactic reaction to the vaccine

Mild adverse effects include redness, swelling, and soreness at the injection site.

More Information

The following English-language resources may be useful. Please note that THE MANUAL is not responsible for the content of these resources.

Drugs Mentioned In This Article

Drug Name Select Trade
Adacel, Boostrix, Certiva, Daptacel, Infanrix, Tri-Immunol, Tripedia
NOTE: This is the Professional Version. CONSUMERS: View Consumer Version
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