Key points
- CDC recommends diphtheria vaccines for people across the lifespan.
- Follow the recommended immunization schedule to ensure that your patients get the diphtheria vaccines that they need.
Background
Constrained U.S. Td supply, 2024
The United States uses three types of combination vaccines that include protection against diphtheria: DTaP, Tdap, and Td. DT vaccine is no longer available in the United States.
DTaP and Tdap also include protection against tetanus and pertussis. Td also includes protection against tetanus. Children younger than 7 years of age receive DTaP, while older children and adults receive Tdap or Td.
The following summarizes CDC's current age-based recommendations for DTaP, Tdap, and Td. Access the official, full text of CDC's current and historical DTaP/Tdap/Td vaccine recommendations.
Infants and children
CDC recommends routine DTaP vaccination for all infants and children younger than 7 years old.
Administer a 5-dose DTaP series, 1 dose at each of the following ages:
- 2 months
- 4 months
- 6 months
- 15 through 18 months
- 4 through 6 years
Adolescents
CDC recommends routine Tdap vaccination for all adolescents.
Administer a single dose of Tdap at 11 to 12 years of age.
Catch-up guidance
Vaccinate children who miss their shots or start the series later than recommended. Depending on the child's age when vaccination begins, the recommendation varies for
- Type of vaccine
- Number of doses
- Interval between doses
Job aids for simplifying catch-up guidance
Use the following job aids to help interpret table 2 of the child and adolescent immunization schedule.
People who are pregnant
Give a single dose of Tdap during every pregnancy, preferably during the early part of gestational weeks 27 through 36.
Adults
CDC recommends a booster (Td or Tdap) every 10 years for all adults.
Never received Tdap
CDC recommends a single dose of Tdap for adults who've never received Tdap. It can be given at any time, regardless of when they last got Td.
Adults 65 years or older
When feasible, administer Boostrix® (Tdap) to adults 65 years or older. Adacel® (Tdap) is only approved for use up through 64 years of age. However, vaccine providers shouldn't miss an opportunity to vaccinate adults 65 years or older with Tdap. Therefore, providers may administer the Tdap vaccine they have available, and it will be valid.
Healthcare personnel
Healthcare personnel should follow the same immunization guidance provided for all adults.
Patients with a contraindication
A history of a severe allergic reaction (anaphylaxis) to a vaccine component or following a prior dose is a contraindication to further doses.
For patients with a contraindication specific to pertussis-containing vaccines, follow these age-based recommendations:
Children <7 years of age: See About young children with a contraindication to pertussis-containing vaccines.
Persons ≥7 years of age: Use Td instead of Tdap.
Find more resources below about contraindications.
Constrained U.S. Td supply, 2024
Historically, two Td vaccine products have been available for use in the United States:
- TdVaxTM, manufactured by MassBiologics
- Tenivac®, manufactured by Sanofi
MassBiologics has discontinued production of TdVaxTM, which is exclusively distributed by Grifols. Sanofi is taking steps to augment their available U.S. supply of Tenivac®. Despite these efforts, it's anticipated that the supply of Td vaccine in the U.S. market will be constrained during 2024.
Temporary ordering controls are in place in the public and private sectors to help manage the gap in supply. Tdap vaccines are available without supply constraints at this time.
Guidance for vaccine providers
The limited supply of Td vaccine needs to be preserved for those with a contraindication to receiving pertussis-containing vaccines. While Td vaccine supplies are constrained, CDC recommends vaccine providers transition to use of Tdap in lieu of Td whenever possible.
Tdap vaccine is an acceptable alternative to Td vaccine. This includes when a tetanus booster is indicated for wound management. Tdap vaccine isn't an acceptable alternative only when a person has a specific contraindication to pertussis-containing vaccines, which is very rare.
This guidance will remain in place until the period of temporary ordering controls for Td ends.
Resources
Contraindications and precautions
General Best Practice Guidelines for Immunization
Pink Book chapter on
Immunization schedules
Child and adolescent immunization schedule
Vaccine Information Statements
DTaP: English | Other languages
Tdap: English | Other languages
Td: English | Other languages