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Diphtheria, Tetanus, and Whooping Cough Vaccination: What Everyone Should Know

One of the Recommended Vaccines by Disease


Key Facts

Vaccines used today against diphtheria and tetanus (i.e., DT and Td) sometimes also include protection against whooping cough or pertussis (i.e., DTaP and Tdap). DTaP and DT are given to children younger than 7 years old, while Tdap and Td are given to older children and adults.


Who Should Get Diphtheria, Tetanus, and Whooping Cough Vaccines?

CDC recommends diphtheria, tetanus, and whooping cough (pertussis) vaccination for everyone. Vaccines used today against diphtheria and tetanus (i.e., DT and Td) sometimes also include protection against whooping cough (i.e., DTaP and Tdap). Two of these (DTaP and DT) are given to children younger than 7 years old, while two (Tdap and Td) are given to older children and adults.

Talk to your or your child’s healthcare professional about what is best for your specific situation.

Learn about different types and brands of diphtheria, tetanus, and whooping cough vaccines at CDC’s What Are the Types of Diphtheria, Tetanus, and Whooping Cough Vaccines? webpage.

Babies and Children

Babies and young children need three doses of the diphtheria, tetanus, and whooping cough (DTaP) vaccine to build up high levels of protection, and then two booster shots to maintain that protection through early childhood. Doses are recommended at the following ages:

  • 2 months
  • 4 months
  • 6 months
  • 15 through 18 months
  • 4 through 6 years

For children who should not get vaccines that contain protection against whooping cough (for example due to having a very bad reaction to DTaP), DT can be given instead of DTaP.

Preteens and Teens

Preteens should get one dose of the tetanus, diphtheria, and whooping cough (Tdap) vaccine to boost their immunity between the ages of 11 and 12 years. Teens who didn't get Tdap as a preteen should get one dose the next time they visit their healthcare professional.

Pregnant Women

If you are pregnant, you should get a Tdap vaccine during the 3rd trimester of every pregnancy to help protect your baby from whooping cough in the first few months of life. Find out more about the pregnancy recommendation here.

Adults

Adults should get one dose of the tetanus and diphtheria (Td) vaccine every 10 years. For adults who did not get Tdap as a preteen or teen, they should get one dose of Tdap in place of a Td dose to boost protection against whooping cough. However, adults who need protection against whooping cough can get Tdap at any time, regardless of when they last got Td.

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Who Should Not Get These Vaccines?

Because of age or health conditions, some people should not get certain vaccines or should wait before getting them. Read the guidelines below and ask your or your child’s healthcare professional for more information.

DT

Tell the person who is giving your child DT if:

Your child has had a life-threatening allergic reaction or has a severe allergy.

  • Any child who had a life-threatening allergic reaction after a dose of DT should not get another dose.
  • Any child with a severe allergy to any component of DT should not get this vaccine. Your child’s healthcare professional can tell you about the vaccine’s ingredients.

Your child has been diagnosed with specific illnesses or conditions.

  • Talk with your child’s healthcare professional if your child:
    • Has seizures or another nervous system problem.
    • Had severe pain or swelling after any vaccine containing tetanus or diphtheria.
    • Ever had a condition called Guillian-Barré Syndrome (GBS).

Your child is not feeling well.

  • If your child has a mild illness, such as a cold, they can probably get the vaccine. If your child is moderately or severely ill, they should probably wait until they recover. Your child’s healthcare professional can advise you.

Your child is 7 years or older.

  • DT should not be given to anyone 7 years or older. Talk to your child’s healthcare professional about how your child can catch-up on their immunization schedule.
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DTaP

Tell the person who is giving your child DTaP if:

Your child has had a life-threatening allergic reaction.

  • Any child who had a life-threatening allergic reaction after a dose of DTaP should not get another dose.

Your child has been diagnosed with specific illnesses or conditions.

  • Any child who suffered a brain or nervous system disease within 7 days after a dose of DTaP not attributable to another cause should not get another dose.
  • Talk with the healthcare professional if you or your child:
    • Had severe pain or swelling after any vaccine containing tetanus or diphtheria.
    • Ever had a condition called Guillian-Barré Syndrome (GBS).
  • Some of the following children should not get another dose of DTaP vaccine, but may get a vaccine (called DT) that does not include protection against whooping cough. Talk with your child’s healthcare professional if your child:
    • Had a seizure or collapsed after a dose of DTaP.
    • Cried non-stop for three hours or more after a dose of DTaP.
    • Had a fever over 105°F after a dose of DTaP.

Your child is not feeling well.

  • If your child has a mild illness, such as a cold, they can probably get the vaccine. If your child is moderately or severely ill, they should probably wait until they recover. Your child’s healthcare professional can advise you.

Your child is 7 years or older.

  • DTaP should not be given to anyone 7 years or older. Talk to your child’s healthcare professional about how your child can catch-up on their immunization schedule.
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Td

Tell the person who is giving you or your child Td if:

You or your child have had a life-threatening allergic reaction or have a severe allergy.

  • Anyone who has had a life-threatening allergic reaction to a dose of this vaccine or to any tetanus- or diphtheria toxoid-containing vaccine should not get this vaccine.
  • Anyone with a severe allergy to any component of Td should not get this vaccine. Your or your child’s healthcare professional can tell you about the vaccine’s ingredients.

You or your child have had a previous reaction to similar vaccines or have been diagnosed with specific illnesses or conditions.

  • Talk with the healthcare professional if you or your child:
    • Had severe pain or swelling after any vaccine containing tetanus or diphtheria.
    • Ever had a condition called Guillian-Barré Syndrome (GBS).

You or your child are not feeling well.

  • People who have a mild illness, such as a cold, can probably get the vaccine. People who are moderately or severely ill should probably wait until they recover. Your or your child’s healthcare professional can advise you.

Your child is younger than 7 years old.

  • Td should not be given to anyone younger than 7 years old.
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Tdap

Tell the person who is giving you or your child Tdap if:

You or your child have had a life-threatening allergic reaction or have a severe allergy.

  • Anyone who has had a life-threatening allergic reaction to a dose of this vaccine or to any diphtheria toxoid-, tetanus toxoid-, or whooping cough-containing vaccine should not get this vaccine.
  • Anyone with a severe allergy to any component of Tdap should not get this vaccine. Your or your child’s healthcare professional can tell you about the vaccine’s ingredients.

You or your child have had a previous reaction to similar vaccines.

  • Anyone who had coma or long repeated seizures within seven days after a childhood dose of DTP or DTaP, or a previous dose of Tdap, should not get Tdap, unless a cause other than the vaccine was found. They can still get Td.
  • Talk with your or your child’s healthcare professional if you:
    • Have seizures or another nervous system problem.
    • Had severe pain or swelling after any vaccine containing tetanus, diphtheria, or whooping cough.
    • Ever had a condition called Guillian-Barré Syndrome (GBS).

You or your child are not feeling well.

  • People who have a mild illness, such as a cold, can probably get the vaccine. People who are moderately or severely ill should probably wait until they recover. Your or your child’s healthcare professional can advise you.

Your child is younger than 7 years old.

  • Tdap should not be given to anyone younger than 7 years old.
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What Types of Diphtheria, Tetanus, and Whooping Cough Vaccines Are There?

A combination vaccine is when two or more vaccines are given in a single shot in order to decrease the number of shots given.

There are 11 combination vaccines licensed for use in the United States by the Food and Drug Administration (FDA) that help protect against diphtheria and tetanus. Eight of these vaccines also help protect against whooping cough (pertussis).

  • DT (generic) and Td (Tenivac® and generic) provide protection against diphtheria and tetanus.
  • DTaP (Daptacel®, Infanrix®, Kinrix®, Pediarix®, Pentacel®, and Quadracel®) provides protection against diphtheria, tetanus, and whooping cough.
  • Tdap (Adacel®and Boostrix®) provides protection against tetanus, diphtheria, and whooping cough.

Upper-case letters in these abbreviations denote full-strength doses of diphtheria (D) and tetanus (T) toxoids and whooping cough (P) vaccine. Lower-case "d" and "p" denote reduced doses of diphtheria and whooping cough used in the adolescent/adult-formulations. The "a" in DTaP and Tdap stands for "acellular," meaning that the whooping cough component contains only parts of the bacteria instead of the whole cell.

DT Vaccines

  • DT Generic [13 pages]: It is given in a five-dose series to babies and children 6 weeks through 6 years old who should not get vaccines that contain whooping cough.
  • Td Generic [6 pages]: It is given every 10 years as a one-dose booster shot to people 7 years or older. It is given also in a three-dose series to people 7 years or older who have not previously gotten any tetanus and diphtheria vaccines. This vaccine may also be used to complete the childhood vaccine series for tetanus and diphtheria in people 7 years or older.
  • Tenivac® [21 pages]: It is given every 10 years as a one-dose booster shot to people 7 years or older. It is given also in a three-dose series to people 7 years or older who have not previously gotten any tetanus and diphtheria vaccines. This vaccine may also be used to complete the childhood vaccine series for tetanus and diphtheria in people 7 years or older.

Tdap Vaccines

  • Adacel® [28 pages]: It is given as a one-dose booster shot to people 10 through 64 years old.
  • Boostrix®: It is given as a one-dose booster shot to people 10 years or older.

DTaP Vaccines

  • Daptacel®: It is given in a five-dose series to babies and children 6 weeks through 6 years old.
  • Infanrix®: It is given in a five-dose series to babies and children 6 weeks through 6 years old.
  • Kinrix® [13 pages]: It is given as the fifth dose in the DTaP vaccine series and the fourth dose of inactivated poliovirus vaccine (IPV) in children 4 through 6 years old whose previous DTaP vaccine doses have been Infanrix®or Pediarix®for the first three doses and Infanrix® for the fourth dose.
  • Pediarix® [22 pages]: It is given as a three-dose series to babies and children 6 weeks through 4 years old. It also gives protection against poliomyelitis and hepatitis B.
  • Pentacel®: It is given as a four-dose series to babies and children 6 weeks through 4 years old. It also gives protection against poliomyelitis and invasive disease caused by Haemophilus influenzae type b.
  • Quadracel®: It is given as the fifth dose in the DTaP vaccine series and the fourth or fifth dose of inactivated poliovirus vaccine (IPV) in children 4 through 6 years old who have received 4 doses of Pentacel®or Daptacel®vaccine.
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How Well Do These Vaccines Work?

Summary

Vaccines that help protect against diphtheria, tetanus, and whooping cough (DT, DTaP, Td, and Tdap) differ in how well they work against each disease.

The diphtheria and tetanus toxoid components of these vaccines are estimated to work well for people who receive the primary series (which is three doses for people 7 years old or older and four doses for children younger than 7):

  • Nearly everyone (95 out of 100) is protected against diphtheria for approximately 10 years.
  • Nearly everyone is protected against tetanus for approximately 10 years.

In studies showing how well the whooping cough component of DTaP works:

  • Nearly all children (98 out of 100) who get all five doses of DTaP on schedule are fully protected against whooping cough within the year following the last dose.
  • About 7 out of every 10 of children who get all five doses of DTaP on schedule are fully protected against whooping cough five years after getting the last dose of DTaP.

In studies showing how well the whooping cough component of Tdap works:

  • About 7 out of every 10 people are fully protected against whooping cough in the first year after getting it.
  • About 3 or 4 out of every 10 people are fully protected against whooping cough four years after getting it.
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In Depth

In general, diphtheria, tetanus, and whooping cough vaccines work well, but cannot prevent all cases of these serious diseases. Below is information about how well each of the vaccines work against each disease.

Diphtheria

Diphtheria was once a major cause of illness and death among children. The United States recorded 206,000 cases of diphtheria in 1921, resulting in 15,520 deaths. Starting in the 1920s, diphtheria rates dropped quickly in the United States and other countries that began widely vaccinating. In the past decade, there were less than five cases of diphtheria in the Unites States reported to CDC. However, the disease continues to play a role globally with 7,321 cases reported to the World Health Organization in 2014. There are likely many more cases that are not reported.

Diphtheria toxoid-containing vaccines are estimated to protect nearly all people (95 out of 100) for approximately 10 years. Protection decreases over time, so adults need to get a Td (tetanus and diphtheria) booster shot every 10 years to stay protected.

Tetanus

The first version of tetanus-toxoid containing vaccine was introduced into the routine childhood immunization schedule in the late 1940s. At that time, between 500 and 600 cases were reported each year. Tetanus infections steadily declined after the vaccination recommendation. Today, tetanus is uncommon in the United States. There were about 30 reported cases per year between 1996 and 2014. Nearly all cases of tetanus today are in people who never got a tetanus vaccine, or adults who don’t stay up to date on their 10-year booster shots.

Tetanus toxoid-containing vaccines are estimated to protect essentially all people for approximately 10 years. Protection decreases over time, so adults need to get a Td (tetanus and diphtheria) booster shot every 10 years to stay protected.

Whooping Cough

Before whooping cough vaccines became widely available in the 1940s, about 200,000 children got sick with it each year in the United States and about 9,000 died as a result of the infection. After this, whooping cough cases reached an all-time low in the 1980s. Since then, there has been an increase in reported whooping cough cases. There are several reasons that help explain why we are seeing this increase. These include increased awareness, improved diagnostic tests, better reporting, more circulation of the bacteria, and waning immunity (when a vaccine does not provide long-lasting protection). Changes in the genetic makeup of the bacteria that cause whooping cough may also be part of the reason why more cases are being reported.

Helpful Terms

  • Acellular vaccine: A vaccine that is made using part of the bacterium or organism
  • Whole cell vaccine: A vaccine that is made using a weakened form of the entire bacterium or organism

When it comes to waning immunity, it seems that the acellular whooping cough vaccine we use now in children may not protect for as long as the whole cell whooping cough vaccine we used in the past. In the 1990s, the United States switched from whole cell to acellular whooping cough vaccines for babies and children. Whole cell whooping cough vaccines are associated with more minor and short-term side effects, such as fever and pain or swelling at the injection site. Serious neurologic adverse reactions, including chronic neurological problems, occurred rarely in children who recently got a whole cell whooping cough vaccine. While studies have not been able to say for sure if the whole cell whooping cough vaccine could cause chronic neurological problems, public concern in the United States and other countries led to the development of safe and effective acellular whooping cough vaccines for children, teens, and adults.

In general, DTaP is effective for 8 or 9 out of 10 children who get it. Among children who get all five doses of DTaP on schedule, effectiveness is very high within the year following the last dose — nearly all children (98 out of 100) are fully protected. There is a modest decrease in effectiveness in each following year. About 7 out of 10 children are fully protected five years after getting their last dose of DTaP and the other 3 children are protected against serious disease.

In the first year after getting vaccinated, Tdap protects about 7 out of 10 people who get it. There is a decrease in effectiveness in each following year. About 3 or 4 out of 10 people are fully protected four years after getting Tdap.

Learn more about DTaP waning immunity and whooping cough outbreaks.

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What Are the Possible Side Effects of Diphtheria, Tetanus, and Whooping Cough Vaccines?

Most people who get a vaccine that helps protect against diphtheria, tetanus, and whooping cough (DT, DTaP, Td, and Tdap) do not have any serious problems with it. With any medicine, including vaccines, there is a chance of side effects. These are usually mild and go away on their own within a few days, but serious reactions are also possible.

Mild Problems

DT (Diphtheria and Tetanus) Vaccine

Mild problems following DT vaccination can include:

  • Reactions where the shot was given
    • Redness
    • Swelling
    • Soreness or tenderness
  • Fever
  • Loss of appetite
  • Vomiting

DTaP (Diphtheria, Tetanus, and Whooping Cough) Vaccine

Mild problems following DTaP vaccination can include:

  • Reactions where the shot was given
    • Redness
    • Swelling
    • Soreness or tenderness
  • Fever
  • Fussiness (irritability)
  • Feeling tired
  • Loss of appetite
  • Vomiting

Reactions where the shot was given and fever occur more often after the 4th and 5th doses of the DTaP series than after earlier doses. Sometimes the entire arm or leg that the shot was given in swells after the 4th or 5th dose. If this happens, the swelling lasts between 1 and 7 days.

Td (Tetanus and Diphtheria) Vaccine

Mild problems following Td vaccination can include:

  • Reactions where the shot was given
    • Pain
    • Redness
    • Swelling
  • Fever
  • Headache
  • Feeling tired

Tdap (Tetanus, Diphtheria, and Whooping Cough) Vaccine

Mild problems following Tdap vaccination can include:

  • Reactions where the shot was given
    • Pain
    • Redness
    • Swelling
  • Fever
  • Headache
  • Feeling tired
  • Nausea, vomiting, diarrhea, or stomach ache
  • Chills
  • Body aches or sore joints
  • Rash, swollen glands
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Problems that Could Happen after Getting Any Injected Vaccine

  • People sometimes faint after a medical procedure, including vaccination. Sitting or lying down for about 15 minutes can help prevent fainting, and injuries caused by a fall. Tell the healthcare professional if you or your child is feeling dizzy, has vision changes, or has ringing in the ears.
  • Some people get severe pain in the shoulder and have difficulty moving the arm where a shot was given. This happens very rarely.
  • Any medicine can cause a severe allergic reaction. Such reactions from a vaccine are very rare, estimated at about 1 in a million doses, and would happen within a few minutes to a few hours after the vaccination.
  • As with any medicine, there is a very remote chance of a vaccine causing a serious injury or death.

For more information on possible side effects from vaccination, visit CDC’s Possible Side-effects from Vaccines webpage.

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Where Can I Find These Vaccines?

Where to Find Diphtheria, Tetanus, and Whooping Cough Vaccines

Your healthcare professional is usually the best place to receive recommended vaccines for you or your child.

These vaccines are part of the routine childhood immunization schedule. Therefore, vaccines are regularly available at pediatric and family practice offices, as well as community health clinics and public health departments for children and teens.

If your healthcare professional does not have these vaccines for adults, ask for a referral.

Vaccines may also be available at pharmacies, workplaces, community health clinics, health departments, or other community locations such as schools and religious centers. Federally funded health centers can also provide services if you don’t have a regular source of health care. Locate one near you. You can also contact your state health department to learn more about where to get vaccines in your community.

When receiving any vaccine, ask the provider to record the vaccine in the state or local registry, if available. This helps healthcare professionals at future encounters know what vaccines you or your child have already received.

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How Do I Pay for These Vaccines?

There are several ways diphtheria, tetanus, and whooping cough vaccines may be paid for:

Medicare

Medicare Part D plans cover Tdap vaccine, but there may be costs to you depending on your specific plan.

Private Health Insurance

Most private health insurance plans cover these vaccines. Check with your insurance provider for details on whether there is any cost to you and for a list of in-network vaccine providers.

Vaccines for Children Program

The Vaccines for Children (VFC) Program provides vaccines to children whose parents or guardians may not be able to afford them. A child is eligible for the program if they are younger than 19 years of age and meet one of the following requirements:

  • Medicaid-eligible
  • Uninsured
  • American Indian or Alaska Native
  • Underinsured (have health insurance that does not cover vaccines or does not cover certain vaccines)

If your child is VFC-eligible, ask if your healthcare professional is a VFC provider. For help in finding a VFC provider near you, contact your state or local health department’s VFC Program Coordinator or call CDC at 1-800-CDC-INFO (232-4636).

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References

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