However, this analysis and an updated model of the economic impact of substituting Tdap for the decennial Td booster demonstrated that estimates of cost effectiveness are dependent on values for parameters with a high degree of uncertainty, including pertussis incidence, illness severity, initial vaccine effectiveness, duration of protection, and the impact of Tdap on herd protection (38). Reports can be submitted to VAERS online, by fax, or by mail. Coupling such uncertainty with the evidence for notable widespread use of Tdap in place of Td, programmatic issues were the main consideration in the decision-making process. Saving Lives, Protecting People, https://www.cdc.gov/vaccines/acip/recs/grade/tdap-etr.html, https://www.cdc.gov/mmwr/volumes/67/rr/rr6702a1.htm, https://www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html, https://www.cdc.gov/vaccines/acip/committee/members.html, https://www.cdc.gov/vaccines/acip/meetings/downloads/min-archive/min-jun13.pdf, https://www.fda.gov/media/119862/download, https://www.cdc.gov/vaccines/programs/vfc/awardees/vaccine-management/price-list/index.html, https://www.fda.gov/media/124002/download, Centers for Disease Control and Prevention, U.S. Department of Health & Human Services, 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, Tetanus prophylaxis if ≥5 years have elapsed since the last tetanus-containing vaccine, Single dose ≥5 years after a dose of DTaP or Td vaccine.

These situations include decennial Td booster doses, tetanus prophylaxis when indicated for wound management in persons who had previously received Tdap, and for multiple doses in the catch-up immunization schedule for persons aged ≥7 years with incomplete or unknown vaccination history. Clin Infect Dis 2004;39:179–85.

Route of administration: intramuscular. Immunity to pertussis 5 years after booster immunization during adolescence. depends on the nature of the lesion and the history of previous Tetanus antiserum was developed in 1890, with its protective effects lasting a few weeks. Data on the use of >1 Tdap dose in the catch-up immunization schedule are limited. For previously unvaccinated persons aged ≥7 years, a 3-dose catch-up immunization schedule included only 1 dose of Tdap, preferably as the first dose in the series (off-label use in children aged 7–9 years), and 2 subsequent Td doses at specified intervals (5). Atlanta, GA; US Department of Human Services, CDC, National Center for Immunization and Respiratory Diseases; 2018. This report updates ACIP recommendations and guidance regarding the use of Tdap vaccines (3).

Boostrix (GlaxoSmithKline) is approved for a single dose in persons aged ≥10 years; Adacel (Sanofi Pasteur) is approved for persons aged 10–64 years.

If DTaP is administered inadvertently to an undervaccinated child aged 7–9 years, this dose should count as the Tdap dose of the catch-up series, and the child should receive an adolescent Tdap dose at age 11–12 years. In 2013, ACIP reviewed the most recent safety and immunogenicity data available at that time to inform their recommendations regarding a second routine dose of Tdap. Vaccine 2012;30:974–82. A study of the rise and fall in circulating tetanus antitoxin in a group of 15 adults after basic and booster immunization indicates that although individuals vary greatly in their responsiveness to toxoid, the falloff in antitoxin appears to be fractionally constant for each individual, and over periods of 5 to 6 years appears to be the same after successive doses. Summaries of evidence, including the evidence to recommendations framework (https://www.cdc.gov/vaccines/acip/recs/grade/tdap-etr.html) and assessment of programmatic considerations, were presented to ACIP at the October 2018, June 2019, and October 2019 meetings. In light of the new indication for a second dose of Adacel and evidence of Tdap being used frequently in place of Td (29), ACIP reassessed current Tdap recommendations.

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