Version May 2024
Note: Td vaccines (eg, TDVax, Tenivac) are for use in patients ≥7 years of age; DT vaccines (generics) are for use in pediatric patients 6 weeks to <7 years of age. Td vaccines contain less diphtheria toxoid than DT vaccines; the vaccines are not interchangeable.
Whenever feasible, the same manufacturer should be used for all doses of the vaccination series; however, vaccination should not be deferred if a specific brand is not known or is not available. Doses administered ≤4 days before minimum interval or age are considered valid; however, local or state mandates may supersede this timeframe (ACIP [Kroger 2023]).
Booster immunization (Td [eg, TDVax, Tenivac]): IM: 0.5 mL every 10 years (for routine booster in patients who have completed primary immunization series). The Advisory Committee on Immunization Practices (ACIP) prefers Tdap for use in some situations if no contraindications exist (CDC/ACIP [Havers 2020]; CDC/ACIP [Liang 2018]); refer to Diphtheria and Tetanus Toxoids and Acellular Pertussis Vaccine monograph for additional information.
Primary immunization (Td [eg, TDVax, Tenivac]): IM: Patients previously not immunized should receive 2 primary doses of 0.5 mL each, given at an interval of at least 4 weeks; third (reinforcing) dose of 0.5 mL 6 to 12 months later. Patients not completely immunized (<3 doses) should receive the remaining doses. For patients who have not received Tdap, at least one dose should be included as part of primary immunization (in place of one or more of the Td doses; preferably the first dose) (CDC/ACIP [Havers 2020]; CDC/ACIP [Liang 2018]).
Tetanus prophylaxis in wound management (CDC/ACIP [Havers 2020]; CDC/ACIP [Liang 2018]): IM: Tetanus prophylaxis in patients with wounds should be based on if the wound is clean or contaminated and the immunization status of the patient, including time from last tetanus-containing vaccine. Wound management includes use of tetanus toxoid and/or tetanus immune globulin (TIG) where indicated, wound cleaning, and (if required) surgical debridement and the proper use of antibiotics. Patients with an uncertain or incomplete tetanus immunization status should have additional follow-up to ensure a series is completed. Patients with a history of Arthus reaction following a previous dose of a tetanus toxoid-containing vaccine should not receive a tetanus toxoid-containing vaccine until >10 years after the most recent dose, even if they have a wound that is neither clean nor minor. See table.
|
History of tetanus immunization doses |
Clean, minor wounds |
All other woundsa | ||
|---|---|---|---|---|
|
Tetanus toxoidb |
TIG |
Tetanus toxoidb |
TIG | |
|
aSuch as, but not limited to, wounds contaminated with dirt, feces, soil, and saliva; puncture wounds; wounds from crushing, tears, burns, and frostbite. | ||||
|
bTetanus toxoid in this chart refers to a tetanus toxoid-containing vaccine. For children <7 years of age, DTaP (DT, if pertussis vaccine contraindicated) is recommended. For children 7 to 10 years of age who are not fully immunized against pertussis, diphtheria, or tetanus, Tdap should be used (followed by completion of catch-up series). Tdap is preferred in patients ≥11 years of age if the patient has not previously been vaccinated with Tdap, if Tdap history is unknown, or if the patient is pregnant. In patients who have previously been vaccinated with Tdap, either Td or Tdap may be used. | ||||
|
cYes, if ≥10 years since last dose. | ||||
|
dYes, if ≥5 years since last dose. | ||||
|
eFor patients with HIV infection or severe immunodeficiency with contaminated wounds, TIG should be administered, regardless of history of tetanus immunization. | ||||
|
Abbreviations: DT = diphtheria and tetanus toxoids (formulation for <7 years of age); DTaP = diphtheria and tetanus toxoids, and acellular pertussis (formulation for <7 years of age; Daptacel, Infanrix); Td = diphtheria and tetanus toxoids (formulation for ≥7 years of age; TDVax, Tenivac); Tdap = diphtheria and tetanus toxoids, and acellular pertussis (Adacel or Boostrix [formulations for ≥7 years of age]); TIG = tetanus immune globulin. | ||||
|
Uncertain or <3 doses |
Yes |
No |
Yes |
Yes |
|
3 or more doses |
Noc |
No |
Nod |
Noe |
There are no dosage adjustments provided in the manufacturer’s labeling.
There are no dosage adjustments provided in the manufacturer’s labeling.
Refer to adult dosing.
(For additional information see "Diphtheria and tetanus toxoid vaccines (Td [age ≥7 years]; DT [age <7 years] discontinued by manufacturer): Pediatric drug information")
Note: DT vaccines (generics) are for use in pediatric patients 6 weeks to <7 years of age; Td vaccines (eg, TDVax, Tenivac) are for use in patients ≥7 years of age. Td vaccines contain less diphtheria toxoid than DT vaccines; the vaccines are not interchangeable. Consult CDC/ACIP annual immunization schedules for additional information including specific detailed recommendations for catch-up scenarios and/or care of patients with high-risk conditions.
Whenever feasible, the same manufacturer should be used for all doses of the vaccination series; however, vaccination should not be deferred if a specific brand is not known or is not available. Doses administered ≤4 days before minimum interval or age are considered valid; however, local or state mandates may supersede this timeframe (ACIP [Kroger 2023]).
Primary immunization: Note: Only use DT in place of DTaP in patients with contraindication to pertussis-containing vaccines.
CDC (ACIP) recommendations (CDC/ACIP [Liang 2018]): Infants and Children 6 weeks through <7 years: Note: Preterm infants should be vaccinated according to their chronological age from birth:
Pediatric formulation (DT): IM: 0.5 mL per dose for a total of 5 doses administered as follows:
Three doses (primary series), usually given at 2-, 4-, and 6 months of age; may be given as early as 6 weeks of age and repeated every 4 to 8 weeks.
Fourth dose (first booster): Given at ~15 to 18 months of age, but at least 6 months after third dose. The fourth dose may be given as early as 12 months of age, but at least 6 months must have elapsed between the third dose and the fourth dose. The fourth dose does not need to be repeated if inadvertently administered at least 4 months after the third dose.
Fifth dose (second booster): Given at 4 to 6 years of age, prior to starting school or kindergarten; if the fourth dose is given at ≥4 years of age, the fifth dose may be omitted.
Catch-up immunization:
CDC (ACIP) Recommendations (CDC/ACIP [Liang 2018]): Note: Do not restart the series. If doses have been given, begin the below schedule at the applicable dose number.
Infants and Children who start primary immunization series ≥4 months of age through 6 years (prior to seventh birthday): Pediatric formulation (DT) for those with contraindications to pertussis-containing vaccines: IM: 0.5 mL per dose for a total of 4 to 5 doses based on previous vaccination doses received and ages.
Children ≥7 years and Adolescents not fully or never vaccinated against diphtheria or tetanus, or whose vaccination status is not known, but has contraindications to pertussis-containing vaccines or has received sufficient pertussis doses: Adult formulation (Td [eg, TDVax, Tenivac]): IM: 0.5 mL per dose for a total of 3 to 4 doses based on number of previous vaccination doses, intervals, and patient age.
Booster immunization: For routine booster in patients who have completed primary immunization series. The ACIP prefers Tdap for use in some situations if no contraindications exist; refer to Diphtheria and Tetanus Toxoids, and Acellular Pertussis Vaccine monograph for additional information (CDC/ACIP [Havers 2020]; CDC/ACIP [Liang 2018]).
Children ≥11 years and Adolescents ≤18 years: Td (eg, TDVax, Tenivac): IM: 0.5 mL as a single dose; preferred age for booster is 11 to 12 years of age. If not contraindicated, Tdap is the preferred agent for this dose. Booster doses of either Td or Tdap are recommended every 10 years thereafter.
Note: If Tdap was given either inadvertently or as part of catch-up dosing at 7 to 9 years of age, this should not be counted as the adolescent booster dose. The child should still receive Tdap between ages 11 to 12 years. Regular tetanus boosters with either Tdap or Td should be administered every 10 years throughout life (CDC/ACIP [Havers 2020]).
Tetanus prophylaxis in wound management (CDC/ACIP [Havers 2020]; CDC/ACIP [Liang 2018]): Infants, Children, and Adolescents: Tetanus prophylaxis in patients with wounds should be based on if the wound is clean or contaminated, and the immunization status of the patient, including time from last tetanus-containing vaccine. Wound management includes use of tetanus toxoid and/or tetanus immune globulin (TIG) where indicated, wound cleaning, and (if required) surgical debridement and the proper use of antibiotics. Patients with an uncertain or incomplete tetanus immunization status should have additional follow-up to ensure a series is completed. Patients with a history of Arthus reaction following a previous dose of a tetanus toxoid-containing vaccine should not receive a tetanus toxoid-containing vaccine until >10 years after the most recent dose even if they have a wound that is neither clean nor minor. See table.
|
History of Tetanus Immunization (Doses) |
Clean, Minor Wounds |
All Other Wounds1 | ||
|---|---|---|---|---|
|
1Such as, but not limited to, wounds contaminated with dirt, feces, soil, and saliva; puncture wounds; wounds from crushing, tears, burns, and frostbite. | ||||
|
2Tetanus toxoid in this chart refers to a tetanus toxoid containing vaccine. For children <7 years old, DTaP (DT, if pertussis vaccine contraindicated) is recommended. For children 7 to 10 years who are not fully immunized against pertussis, diphtheria, or tetanus, Tdap should be used (followed by completion of catch-up series). Tdap is preferred in patients ≥11 years of age if the patient has not previously been vaccinated with Tdap, if Tdap history is unknown, or if the patient is pregnant. In patients who have previously been vaccinated with Tdap, either Td or Tdap may be used. | ||||
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3Yes, if ≥10 years since last dose. | ||||
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4Yes, if ≥ 5 years since last dose. | ||||
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5For patients with HIV infection or severe immunodeficiency with contaminated wounds, TIG should be administered, regardless of history of tetanus immunization. | ||||
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Abbreviations: DT = Diphtheria and Tetanus Toxoids (formulation for age <7 years); DTaP = Diphtheria and Tetanus Toxoids, and Acellular Pertussis (formulation for age <7 years; Daptacel, Infanrix); Td = Diphtheria and Tetanus Toxoids (formulation for age ≥7 years; TDVax, Tenivac); Tdap = Diphtheria and Tetanus Toxoids, and Acellular Pertussis (Adacel or Boostrix [formulations for age ≥7 years]); TIG = Tetanus Immune Globulin | ||||
|
Tetanus toxoid 2 |
TIG |
Tetanus toxoid 2 |
TIG | |
|
Uncertain or <3 doses |
Yes |
No |
Yes |
Yes |
|
3 or more doses |
No3 |
No |
No4 |
No5 |
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
All serious adverse reactions must be reported to the US Department of Health and Human Services (DHHS) Vaccine Adverse Event Reporting System (VAERS) 1-800-822-7967 or online at https://vaers.hhs.gov/esub/index. In Canada, adverse reactions may be reported to local provincial/territorial health agencies or to the Vaccine Safety Section at Public Health Agency of Canada (1-866-844-0018).
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Percentages noted within 2 weeks following booster dose of Decavac in persons ≥11 years of age.
>10%:
Central nervous system: Headache (34% to 40%), fatigue (21% to 27%), body pain (≤19% to 30%), myasthenia (≤19% to 30%), chills (7% to 13%)
Gastrointestinal: Nausea (8% to 12%), diarrhea (10% to 11%)
Local: Pain at injection site (63% to 71%), erythema at injection site (20% to 22%), swelling at injection site (17% to 18%)
Neuromuscular & skeletal: Arthralgia (≤7% to 12%), joint swelling (≤7% to 12%)
1% to 10%:
Dermatologic: Skin rash (2%)
Gastrointestinal: Vomiting (2% to 3%)
Hematologic & oncologic: Adenopathy (4% to 5%)
Miscellaneous: Fever (1% to 3%)
<1%, postmarketing and/or case reports: Anaphylaxis, arthralgia, dizziness, hypersensitivity reaction (includes angioedema, skin rash, urticaria), injection site reaction (includes cellulitis, induration at injection site, injection site nodule, warm sensation at injection site), limb pain, lymphadenopathy, musculoskeletal stiffness, myalgia, pain, paresthesia, peripheral edema, seizure, syncope, weakness
Hypersensitivity to diphtheria, tetanus toxoid, or any component of the formulation
Concerns related to adverse effects:
• Anaphylactoid/hypersensitivity reactions: Immediate treatment (including epinephrine 1 mg/mL) for anaphylactoid and/or hypersensitivity reactions should be available during vaccine use (ACIP [Kroger 2023]).
• Arthus-type hypersensitivity: Patients with a history of severe local reaction (Arthus-type) following a previous diphtheria toxoid or tetanus toxoid-containing vaccine dose should not be given further routine or emergency doses of Td unless ≥10 years since most recent dose, even if using for wound management with wounds that are not clean or minor; these patients generally have high serum antitoxin levels (CDC/ACIP [Liang 2018]).
• Shoulder injury related to vaccine administration: Vaccine administration that is too high on the upper arm may cause shoulder injury (eg, shoulder bursitis, tendinopathy) resulting in shoulder pain and reduced range of motion following injection. Use proper injection technique for vaccines administered in the deltoid muscle (eg, injecting in the central, thickest part of the muscle) to reduce the risk of shoulder injury related to vaccine administration (Cross 2016; Foster 2013).
• Syncope: Syncope has been reported with use of injectable vaccines and may result in serious secondary injury (eg, skull fracture, cerebral hemorrhage); typically reported in adolescent and young adults and within 15 minutes after vaccination. Procedures should be in place to avoid injuries from falling and to restore cerebral perfusion if syncope occurs (ACIP [Kroger 2023]).
Disease-related concerns:
• Acute illness: The decision to administer or delay vaccination because of current or recent febrile illness depends on the severity of symptoms and the etiology of the disease. Postpone administration in patients with moderate or severe acute illness (with or without fever); vaccination should not be delayed for patients with mild acute illness (with or without fever) (ACIP [Kroger 2023]).
• Bleeding disorders: Use with caution in patients with bleeding disorders (including thrombocytopenia); bleeding/hematoma may occur from IM administration; if the patient receives antihemophilia or other similar therapy, IM injection can be scheduled shortly after such therapy is administered (ACIP [Kroger 2023]).
• Guillain-Barré syndrome: Use with caution if Guillain-Barré syndrome occurred within 6 weeks of prior tetanus toxoid-containing vaccine (CDC/ACIP [Liang 2018]).
Concurrent drug therapy issues:
• Anticoagulant therapy: Use with caution in patients receiving anticoagulant therapy; bleeding/hematoma may occur from IM administration (ACIP [Kroger 2023]).
• Vaccines: In order to maximize vaccination rates, the ACIP recommends simultaneous administration (ie, >1 vaccine on the same day at different anatomic sites) of all age-appropriate vaccines (live or nonlive) for which a person is eligible at a single visit, unless contraindications exist. The use of combination vaccines is generally preferred over separate injections, taking into consideration provider assessment, patient preference, and adverse events. When using combination vaccines, the minimum age for administration is the oldest minimum age for any individual component; the minimum interval between dosing is the greatest minimum interval between any individual component. The ACIP prefers each dose of a specific vaccine in a series come from the same manufacturer when possible; however, vaccination should not be deferred because a specific brand name is unavailable (ACIP [Kroger 2023]).
Special populations:
• Altered immunocompetence: Postpone vaccination during periods of severe immunosuppression (eg, patients receiving chemo/radiation therapy or other immunosuppressive therapy [including high-dose corticosteroids]) if appropriate; may have a reduced response to vaccination. In general, household and close contacts of persons with altered immunocompetence may receive all age-appropriate vaccines. Nonlive vaccines should be administered ≥2 weeks prior to planned immunosuppression when feasible; nonlive vaccines administered during chemotherapy should be readministered after immune competence is regained (ACIP [Kroger 2023]; IDSA [Rubin 2014]).
• Pediatric: Pediatric dosage form (DT) should only be used in patients 6 weeks to ≤6 years of age. Td should be administered to children ≥7 years of age. Apnea has occurred following IM vaccine administration in premature infants; consider clinical status implications. In general, preterm infants should be vaccinated at the same chronological age as full-term infants (ACIP [Kroger 2023]).
Dosage form specific issues:
• DT confused with Td: Do not confuse pediatric diphtheria and tetanus (DT) with adult tetanus and diphtheria (Td).
• Latex: Some products may contain natural latex/natural rubber.
• Thimerosal: Some products may contain thimerosal.
Other warnings/precautions:
• Antipyretics: Antipyretics have not been shown to prevent febrile seizures. Antipyretics may be used to treat fever or discomfort following vaccination (ACIP [Kroger 2023]). One study reported that routine prophylactic administration of acetaminophen to prevent fever prior to vaccination decreased the immune response of some vaccines; the clinical significance of this reduction in immune response has not been established (Prymula 2009).
• Appropriate use: Use of this vaccine for specific medical and/or other indications (eg, immunocompromising conditions, hepatic or kidney disease, diabetes) is also addressed in the annual ACIP Recommended Immunization Schedules (refer to CDC schedule for detailed information). Specific recommendations for vaccination in immunocompromised patients with asplenia, cancer, HIV infection, cerebrospinal fluid leaks, cochlear implants, hematopoietic stem cell transplant (prior to or after), sickle cell disease, solid organ transplant (prior to or after), or those receiving immunosuppressive therapy for chronic conditions as well as contacts of immunocompromised patients are available from the IDSA (Rubin 2014).
• Effective immunity: Vaccination may not result in effective immunity in all patients. Response depends upon multiple factors (eg, type of vaccine, age of patient) and may be improved by administering the vaccine at the recommended dose, route, and interval (ACIP [Kroger 2023]).
Diphtheria and tetanus toxoid is available in two formulations which contain different amounts of the diphtheria toxoid; DT or "pediatric" formulation has twice the diphtheria toxoid as Td or "adult" toxoid; use of DT in children >7 years and adults is associated with more severe adverse reactions to the diphtheria toxoid than in infants and younger children.
Sanofi Pasteur discontinued production and distribution of Diphtheria and Tetanus Toxoids Adsorbed (DT) (diphtheria 25 Lf and tetanus 5 Lf per 0.5 mL) and is withdrawing its licenses in all countries. The last lot was manufactured in October 2020 with an expiry date of April 2023.
Td vaccines (eg, TDVax, Tenivac) are for use in patients ≥7 years of age; DT vaccines (generics) are for use in pediatric patients 6 weeks to <7 years of age. Td vaccines contain less diphtheria toxoid than DT vaccines; the vaccines are not interchangeable (CDC/ACIP [Havers 2020]).
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Injectable, Intramuscular [preservative free]:
Tenivac: Diphtheria 2 Lf and tetanus 5 Lf per 0.5 mL (0.5 mL) [latex free; contains formaldehyde solution]
Tenivac: Diphtheria 2 Lf and tetanus 5 Lf per 0.5 mL (0.5 mL)
Suspension, Intramuscular:
TDVax: Diphtheria 2 Lf and tetanus 2 Lf per 0.5 mL (0.5 mL) [contains aluminum phosphate, formaldehyde solution, thimerosal (thiomersal)]
Generic: Diphtheria 2 Lf and tetanus 2 Lf per 0.5 mL (0.5 mL)
Suspension, Intramuscular [preservative free]:
Generic: Diphtheria 25 Lf and tetanus 5 Lf per 0.5 mL (0.5 mL [DSC])
May be product dependent
Injection (Tenivac Intramuscular)
5-2 lfu (per 0.5 mL): $44.22
Suspension (TDVax Intramuscular)
2-2 lf/0.5 mL (per 0.5 mL): $33.58
Suspension (Tetanus-Diphtheria Toxoids Td Intramuscular)
2-2 lf/0.5 mL (per 0.5 mL): $0.00
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Injectable, Intramuscular:
Generic: Diphtheria 2 Lf and tetanus 5 Lf per 0.5 mL (0.5 mL)
IM: For IM administration only; not for IV or SubQ administration. Prior to use, shake suspension well. Do not mix with other vaccines or injections; separate needles and syringes should be used for each injection. To prevent syncope-related injuries, patients should be vaccinated while seated or lying down (ACIP [Kroger 2023]). US law requires that the date of administration, the vaccine manufacturer, lot number of vaccine, Vaccine Information Statement (VIS) edition date and date it was provided, and the administering person's name, title, and address be recorded.
Td (eg, TDVax, Tenivac): Administer in the deltoid muscle; do not inject in the gluteal area. Use proper injection technique in the deltoid muscle (eg, injecting in the central, thickest part of the muscle) to reduce the risk of shoulder injury related to vaccine administration (Cross 2016; Foster 2013).
For patients at risk of hemorrhage following intramuscular injection, the vaccine should be administered intramuscularly if, in the opinion of the physician familiar with the patient's bleeding risk, the vaccine can be administered by this route with reasonable safety. If the patient receives antihemophilia or other similar therapy, intramuscular vaccination can be scheduled shortly after such therapy is administered. A fine needle (23-gauge or smaller) can be used for the vaccination and firm pressure applied to the site (without rubbing) for at least 2 minutes. The patient should be instructed concerning the risk of hematoma from the injection. Patients on anticoagulant therapy should be considered to have the same bleeding risks and treated as those with clotting factor disorders (ACIP [Kroger 2023]).
IM: Prior to use, shake suspension well; not for IV or SubQ administration. Do not mix with other vaccines or injections; separate needles and syringes should be used for each injection (ACIP [Kroger 2023]). To prevent syncope-related injuries, adolescents should be vaccinated while seated or lying down (ACIP [Kroger 2023]). US law requires that the date of administration, the vaccine manufacturer, lot number of vaccine, vaccine information statement (VIS) edition date and date provided, and the administering person's name, title, and address be entered into the patient's permanent medical record.
DT: Administer IM in either the anterolateral aspect of the thigh or the deltoid muscle; do not inject in the gluteal area. If administering in the deltoid muscle, use proper injection technique (eg, injecting in the central, thickest part of the muscle) to reduce the risk of shoulder injury related to vaccine administration (Cross 2016; Foster 2013).
Td (eg, TDVax, Tenivac): Administer IM in the deltoid muscle; do not inject in the gluteal area. Use proper injection technique in the deltoid muscle (eg, injecting in the central, thickest part of the muscle) to reduce the risk of shoulder injury related to vaccine administration (Cross 2016; Foster 2013).
For patients at risk of hemorrhage following IM injection, the vaccine should be administered IM if, in the opinion of the physician familiar with the patient's bleeding risk, the vaccine can be administered by this route with reasonable safety. If the patient receives antihemophilia or other similar therapy, IM vaccination can be scheduled shortly after such therapy is administered. A fine needle (23-gauge or smaller) should be used for the vaccination and firm pressure on the site (without rubbing) for at least 2 minutes. The patient should be instructed concerning the risk of hematoma from the injection. Patients on anticoagulant therapy should be considered to have the same bleeding risks and treated as those with clotting factor disorders (ACIP [Kroger 2023]).
In the United States, the appropriate CDC-approved Vaccine Information Statement (VIS) must be provided to the patient/caregiver before administering each dose of this vaccine; the VIS edition date and date it was provided to the patient/caregiver should be recorded as required by US law; VIS is available at http://www.cdc.gov/vaccines/hcp/vis/vis-statements/td.html.
Diphtheria and tetanus disease prevention:
Diphtheria and tetanus toxoids adsorbed pediatric formulation (DT): Infants ≥6 weeks of age and children through 6 years of age: Active immunization against diphtheria and tetanus when pertussis vaccine is contraindicated; has also been used for tetanus prophylaxis in wound management.
Tetanus and diphtheria toxoids adsorbed adult formulation (Td) (eg, TDVax, Tenivac): Children ≥7 years of age, adolescents, and adults: Active immunization against diphtheria and tetanus; tetanus prophylaxis in wound management.
The Advisory Committee on Immunization Practices (ACIP) recommends vaccination for the following (CDC/ACIP [Havers 2020]; CDC/ACIP [Liang 2018]):
• For primary immunization against diphtheria and tetanus in infants and children 6 weeks to <7 years of age in whom pertussis vaccine is contraindicated.
• Children ≥7 years of age, adolescents, and adults should receive a booster dose of Td or Tdap every 10 years.
• Children ≥7 years of age, adolescents, and adults: For wound management to prevent tetanus in patients with unknown or <3 doses of previous tetanus vaccine, or who have not received a tetanus-containing vaccine recently (ie, 10 years for clean and minor wounds; 5 years for all other wounds). Tetanus immune globulin is also recommended for some wounds. Tdap is preferred over Td in persons ≥11 years of age who have not previously received Tdap, whose vaccination status is not known, or who are pregnant.
• For patients who have recovered from tetanus or diphtheria infection: Because tetanus or diphtheria infection does not confer life-long immunity, active vaccination should be initiated at the time of recovery from the illness (according to the schedule). If the primary tetanus vaccination series has been completed, then a booster dose should be administered as soon as feasible during convalescence. Persons with unknown or uncertain previous tetanus vaccination histories should begin the 3-dose tetanus and diphtheria toxoids vaccination series.
Tetanus and Diphtheria and Toxoids (Td) may be confused with tuberculin purified protein derivative (PPD)
Pediatric diphtheria and tetanus (DT) may be confused with adult tetanus and diphtheria (Td)
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Acetaminophen: May diminish the therapeutic effect of Vaccines. Management: Consider avoiding routine prophylactic use of acetaminophen before or during vaccine administration when possible. Acetaminophen is still recommended to treat fevers and/or pain that occurs after vaccination. Risk D: Consider therapy modification
Anti-CD20 B-Cell Depleting Therapies: May diminish the therapeutic effect of Vaccines (Inactivated/Non-Replicating). Management: Give inactivated vaccines at least 2 weeks prior to initiation or 6 months after anti-CD20 B-cell depleting therapies. If vaccinated prior to B cell recovery, consider assessing immune response to vaccination. Risk D: Consider therapy modification
Cladribine: May diminish the therapeutic effect of Vaccines (Inactivated/Non-Replicating). Management: Give inactivated vaccines at least 2 weeks prior to initiation of cladribine when possible. Patients vaccinated less than 14 days before initiating or during cladribine should be revaccinated at least 3 months after therapy is complete. Risk D: Consider therapy modification
Corticosteroids (Systemic): May diminish the therapeutic effect of Vaccines (Inactivated/Non-Replicating). Management: Administer vaccines at least 2 weeks prior to immunosuppressive corticosteroids if possible. If patients are vaccinated less than 14 days prior to or during such therapy, repeat vaccination at least 3 months after therapy if immunocompetence restored. Risk D: Consider therapy modification
Elivaldogene Autotemcel: May enhance the adverse/toxic effect of Vaccines. Specifically, there may be a greater risk for contracting an infection from any live vaccine. Elivaldogene Autotemcel may diminish the therapeutic effect of Vaccines. Management: Administration of vaccines is not recommended in the 6 weeks before myeloablative conditioning, and until hematologic recovery after elivaldogene autotemcel treatment. Risk X: Avoid combination
Fingolimod: May diminish the therapeutic effect of Vaccines (Inactivated/Non-Replicating). Management: Vaccine efficacy may be reduced. Complete all age-appropriate vaccinations at least 2 weeks prior to starting fingolimod. If vaccinated during fingolimod therapy, revaccinate 2 to 3 months after fingolimod discontinuation. Risk D: Consider therapy modification
Immunosuppressants (Cytotoxic Chemotherapy): May diminish the therapeutic effect of Vaccines (Inactivated/Non-Replicating). Management: Give inactivated vaccines at least 2 weeks prior to initiation of chemotherapy when possible. Patients vaccinated less than 14 days before initiating or during chemotherapy should be revaccinated at least 3 months after therapy is complete. Risk D: Consider therapy modification
Immunosuppressants (Miscellaneous Oncologic Agents): May diminish the therapeutic effect of Vaccines (Inactivated/Non-Replicating). Management: Give inactivated vaccines at least 2 weeks prior to initiation of immunosuppressants when possible. Patients vaccinated less than 14 days before initiating or during therapy should be revaccinated at least 3 after therapy is complete. Risk D: Consider therapy modification
Immunosuppressants (Therapeutic Immunosuppressant Agents): May diminish the therapeutic effect of Vaccines (Inactivated/Non-Replicating). Management: Give inactivated vaccines at least 2 weeks prior to initiation of immunosuppressants when possible. Patients vaccinated less than 14 days before initiating or during therapy should be revaccinated at least 2 to 3 months after therapy is complete. Risk D: Consider therapy modification
Meningococcal (Groups A / C / Y and W-135) Conjugate Vaccine: Tetanus Toxoids Vaccines may diminish the therapeutic effect of Meningococcal (Groups A / C / Y and W-135) Conjugate Vaccine. Management: When possible, administer the meningococcal polysaccharide (groups A / C / Y and W-135) conjugate vaccine (Nimenrix brand) either together with, or at least one month before, a tetanus toxoids-containing vaccine. Risk D: Consider therapy modification
Methotrexate: May diminish the therapeutic effect of Vaccines (Inactivated/Non-Replicating). Management: Administer vaccines at least 2 weeks prior to methotrexate initiation, if possible. If patients are vaccinated less than 14 days prior to or during methotrexate therapy, repeat vaccination at least 3 months after therapy if immunocompetence restored. Risk D: Consider therapy modification
Propacetamol: May diminish the therapeutic effect of Vaccines. Management: Consider avoiding routine prophylactic use of propacetamol before or during vaccine administration when possible. Propacetamol is still recommended to treat fevers and/or pain that occurs after vaccination. Risk D: Consider therapy modification
Siponimod: May diminish the therapeutic effect of Vaccines (Inactivated/Non-Replicating). Management: Avoid administration of vaccines (inactivated) during treatment with siponimod and for 1 month after discontinuation due to potential decreased vaccine efficacy. Risk D: Consider therapy modification
Teplizumab: May diminish the therapeutic effect of Vaccines (Inactivated/Non-Replicating). Management: Vaccination with inactivated or non-replicating vaccines is not recommended in the 2 weeks prior to teplizumab therapy, during treatment, or for 6 weeks following completion of therapy. Risk D: Consider therapy modification
Nonlive bacterial vaccines have not been shown to cause increased risks to the fetus (ACIP [Kroger 2023]). Diphtheria toxoid and tetanus toxoid vaccines may be used during pregnancy (CDC/ACIP [Liang 2018]).
The Advisory Committee on Immunization Practices (ACIP) recommends a single Tdap vaccination during each pregnancy; ideally early in the period between 27 and 36 weeks' gestation to maximize passive antibody transfer to the fetus. Pregnant females who are not immunized or are only partially immunized should complete the primary series with Td or Tdap. Tetanus immune globulin and a tetanus toxoid containing vaccine are recommended by the ACIP as part of the standard wound management to prevent tetanus in pregnant females; the use of a tetanus-toxoid containing vaccine during pregnancy (with preference given to Tdap) is recommended for wound management if ≥5 years have passed since the last Td vaccination (CDC/ACIP [Havers 2020]); CDC/ACIP [Liang 2018]).
It is not known if components of this vaccine are present in breast milk.
According to the manufacturer, the decision to continue or discontinue breastfeeding following immunization should consider the risk of infant exposure, the benefits of breastfeeding to the infant, and the benefits of vaccination to the mother. Nonlive vaccines have not been shown to affect the safety of the breastfed infant or mother (ACIP [Kroger 2023]). Breastfeeding infants should be vaccinated according to the recommended schedules (ACIP [Kroger 2023]). Advisory Committee on Immunization Practices recommends that if Tdap was not administered during pregnancy, it should be administered during the immediate postpartum period to those with no history of Tdap; women who are not immunized or are only partially immunized should complete the primary series with Td or Tdap (CDC/ACIP [Havers 2020]; CDC/ACIP [Liang 2018]).
Monitor for hypersensitivity and syncope for 15 minutes following administration (ACIP [Kroger 2023]). If seizure-like activity associated with syncope occurs, maintain patient in supine or Trendelenburg position to reestablish adequate cerebral perfusion.
Promotes active immunity to diphtheria and tetanus by inducing production of specific antibodies.
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