FDA–approved and off-label recommendations for licensed tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) products — United States, 2019
January 24th, 2020Havers FP, Moro PL, Hunter P, Hariri S, Bernstein H. Use of Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis Vaccines: Updated Recommendations of the Advisory Committee on Immunization Practices — United States, 2019. MMWR Morb Mortal Wkly Rep 2020;69:77–83. DOI: http://dx.doi.org/10.15585/mmwr.mm6903a5external icon
| Licensed Tdap product | FDA-approved indications for use and administration | Off-label uses | ||
|---|---|---|---|---|
| Decennial Td booster | Tetanus prophylaxis for wound management | Catch-up immunization,* including during pregnancy† | ||
| Adacel§ | Age: 10–64 years | Age: ≥65 years | Age: <10 or ≥65 years | Age: 7–9 years |
| Routine booster ≥5 years after a dose of DTaP or Td vaccine, with a second dose ≥8 years after first (any) Tdap dose | Any dose beyond second Adacel dose administered ≥8 years after first Tdap dose | >1 Tdap dose | ||
| Tetanus prophylaxis if ≥5 years have elapsed since the last tetanus-containing vaccine | ||||
| Boostrix§ | Age: ≥10 years | Any dose if previously received Tdap | Age: <10 years | Age: 7–9 years |
| Single dose ≥5 years after a dose of DTaP or Td vaccine | Any dose if previously received Tdap | >1 Tdap dose | ||
| Tetanus prophylaxis if no previous Tdap | ||||
Abbreviations: DTaP = diphtheria and tetanus toxoids and acellular pertussis vaccine; Td = tetanus and reduced diphtheria toxoid.
* Persons with incomplete or unknown vaccination history should receive a single dose of Tdap, preferably as the first dose of the 3-dose catch-up series; if additional tetanus toxoid–containing doses are needed, either Td or Tdap vaccine may be used.
† Both Tdap vaccines may be administered during pregnancy with the same intervals and restrictions (vaccine specific) as would apply to a nonpregnant person.
§ Package inserts for indications and intervals for wound management are available at https://www.fda.gov/media/119862/downloadexternal icon (Adacel) and https://www.fda.gov/media/124002/downloadexternal icon (Boostrix).