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Tdap – tetanus, diphtheria, acellular pertussis vaccine

Combined inactivated bacterial vaccine (Td + acellular pertussis)

ATC code: J07AJ52

Updated · Methodology

Indications

A

Maternal vaccination

First line

Active maternal immunization against pertussis. Per CDC ACIP 2023, 2023, SEGO 2023 – every pregnancy at 27–36 weeks, optimally 27-30. Reduces pertussis in infants <3 months by 78–91% (Baxter, Pediatrics 2017; Skoff, CID 2017). Tetanus/diphtheria booster every 10 years.

Sources

  1. CAV-AEP: Manual de vacunas en linea de la AEP. Cap. 39: Tosferina (2024)
  2. MMWR (ACIP): Use of Tdap Vaccines: Updated ACIP Recommendations (2020)
  3. The Lancet: Effectiveness of maternal pertussis vaccination in England: observational study (2014)
  4. Clinical Infectious Diseases: Impact of the US Maternal Tetanus, Diphtheria, and Acellular Pertussis Vaccination Program (2017)
  5. Pediatrics: Effectiveness of Vaccination During Pregnancy to Prevent Infant Pertussis (2017)

ICD-10: Z23 · ICD-11: QC00

A

Routine tetanus, diphtheria and pertussis booster (adolescents and adults)

First line

One Tdap dose for adolescents at 11–12 years, then a Td or Tdap booster every 10 years. Covers three infections at once: tetanus, diphtheria and pertussis. Per ACIP (MMWR 2020) and the Spanish AEP schedule, this is the standard way to maintain immunity in adolescents and adults, with no alternative.

Sources

  1. MMWR (ACIP): Use of Tdap Vaccines: Updated ACIP Recommendations (2020)
  2. Comité Asesor de Vacunas de la AEP: Manual de vacunas en línea de la AEP. 38. Tétanos (2024)
  3. AEMPS CIMA: Ficha técnica de Boostrix (Tdap), sección 4.1 indicaciones (2024)

ICD-10: Z23 · ICD-11: QC00

How to read tiers A–F
  • AStrong evidence – first or second line in international guidelines
  • BRecommended in selected cases
  • CStudy data contradict each other
  • DBenefit not proven, no documented harm
  • FDocumented harm, or risk without benefit

Mechanism of action

Contains tetanus toxoid, reduced-dose diphtheria toxoid (d, adult), and 3–5 acellular pertussis components (pertactin, FHA, pertussis toxoid, fimbriae). Induces IgG against all three pathogens. Active maternal immunization at 27–36 weeks is the most effective strategy to protect newborns from pertussis.

Safety

Contraindications

  • Anaphylaxis to previous dose or components
  • Encephalopathy within 7 days of prior pertussis-containing vaccine
  • Acute febrile illness (defer)

Serious adverse effects

  • Anaphylaxis
  • Guillain-Barré syndrome (very rare)

Common adverse effects

  • Injection-site pain/swelling (60%)
  • Fatigue
  • Headache
  • Myalgia
  • Low-grade fever

Pregnancy: can you take Tdap – tetanus, diphtheria, acellular pertussis vaccine?

Recommended at 27–36 weeks each pregnancy. Safe.

Breastfeeding: can you take Tdap – tetanus, diphtheria, acellular pertussis vaccine?

Hale L1 · Compatible

Fully compatible. Hale L1.

Calculate RIDFull profile on NIH LactMed ↗

Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.

Practical notes

Timing and administration

Each pregnancy at 27–36 weeks, optimally 27-30. Cocoon strategy – all adult infant contacts vaccinated ≥2 weeks before contact.

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Frequently asked

What is Tdap – tetanus, diphtheria, acellular pertussis vaccine used for?

Tdap – tetanus, diphtheria, acellular pertussis vaccine is evaluated for the following indications with varying evidence strength: Vaccination during breastfeeding (evidence tier A), Maternal vaccination (evidence tier A), Routine tetanus, diphtheria and pertussis booster (adolescents and adults) (evidence tier A). See the full indication matrix with dosing and citations above on this page.

What are the side effects of Tdap – tetanus, diphtheria, acellular pertussis vaccine?

Common side effects of Tdap – tetanus, diphtheria, acellular pertussis vaccine (≥ 1 in 100): Injection-site pain/swelling (60%), Fatigue, Headache, Myalgia, Low-grade fever. See the Safety section for uncommon and serious reactions.

Is Tdap – tetanus, diphtheria, acellular pertussis vaccine safe during pregnancy?

Recommended at 27–36 weeks each pregnancy. Safe.

Is Tdap – tetanus, diphtheria, acellular pertussis vaccine compatible with breastfeeding?

Fully compatible. Hale L1.

Who should not take Tdap – tetanus, diphtheria, acellular pertussis vaccine?

Tdap – tetanus, diphtheria, acellular pertussis vaccine is contraindicated in: Anaphylaxis to previous dose or components; Encephalopathy within 7 days of prior pertussis-containing vaccine; Acute febrile illness (defer). Full list in the Safety section.

Other drugs in this group

COVID-19 vaccine, mRNA (Moderna), COVID-19 vaccine, mRNA (Pfizer-BioNTech), Hepatitis A vaccine, inactivated, Hepatitis B vaccine, recombinant, Inactivated influenza vaccine, Pneumococcal conjugate vaccine PCV20, HPV vaccine, nonavalent, MMR – measles, mumps, rubella vaccine (live)