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Tetanus-Diphtheria Vaccine

By

Margot L. Savoy

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

Last full review/revision Oct 2020| Content last modified Oct 2020
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NOTE: This is the Professional Version. CONSUMERS: Click here for the Consumer Version

A vaccine for tetanus alone is available, but the tetanus vaccine is typically combined with those for diphtheria and/or pertussis. The vaccine for diphtheria is available only in combination with other vaccines.

Preparations

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. Tetanus-diphtheria-pertussis (Tdap) is an adolescent and adult preparation that contains a pertussis component.

Indications

Tetanus-diphtheria (Td) or Tdap boosters are given routinely every 10 years after the Tdap booster is given at age 11 to 12 years. 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 or Tdap booster if ≥ 5 years have elapsed since the previous dose. One dose of Tdap should be substituted for a Td booster if adults have never received Tdap.

Pregnant women should receive 1 dose of Tdap during each pregnancy, irrespective of their history of receiving the vaccine. Tdap should be administered at 27 to 36 weeks gestation, preferably during the earlier part of this period, although it may be administered at any time during pregnancy.

Contraindications and Precautions

The main contraindication for Td is

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

Precautions with Td include

  • Guillain-Barré syndrome within 6 weeks 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 years since the last dose of a vaccine that contains tetanus toxoid)

Dose and Administration

The Td dose is 0.5 mL IM. Booster vaccinations are given every 10 years.

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.

More Information

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

Click here for Patient Education
NOTE: This is the Professional Version. CONSUMERS: Click here for the Consumer Version
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