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Administration of the diphtheria-tetanus-acellular pertussis (DTaP) vaccine is routinely recommended in children, with a single booster dose of a vaccine containing tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) recommended for 11- to 12-year-olds, followed by tetanus toxoid and the reduced diphtheria toxoid in the form of Td recommended at 10-year intervals throughout life. Despite these recommendations, immunity to tetanus and diphtheria continues to wane among adults in the United States.

●The United States Advisory Committee on Immunization Practices (ACIP) recommends a single dose of a vaccine containing tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) 0.5 mL intramuscularly [IM] in place of Td for all adults aged 19 years and older who have not received Tdap previously to address waning immunity against pertussis. The ACIP recommends that all pregnant women receive vaccination against pertussis with Tdap during each pregnancy.

●Regardless of prior tetanus and diphtheria immunization, Td immunization should be reviewed when anyone presents with an acute injury or wound and prophylaxis administered as indicated. In addition to tetanus immunization, human tetanus immune globulin is indicated in individuals who have sustained a wound that is more severe than a clean and minor wound (eg, wounds contaminated with dirt, feces, soil, or saliva; puncture wounds; avulsions; wounds resulting from missiles, crushing, burns, or frostbite) and who have either received fewer than three doses of tetanus toxoid previously or in whom the number of previous doses is unknown.

●If there is any doubt about whether or not an adult received the primary series, three doses of Td should be administered; the first dose and second dose should be separated by four weeks and the third dose should be given 6 to 12 months later. Tdap should be used in place of Td in adults who have an indication.