Diphtheria, Tetanus, and Whooping

Cough Vaccination: What Everyone

Should Know
https://www.cdc.gov/vaccines/vpd/dtap-tdap-td/public/index.html

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). Babies and children younger than 7 years old receive DTaP
or DT, while older children and adults receive Tdap and Td.

Who Should Get Diphtheria, Tetanus, and Whooping

Cough Vaccines?
CDC recommends diphtheria, tetanus, and whooping cough (pertussis)
vaccination for everyone.

Talk to your or your child’s healthcare professional if you have questions

about diphtheria, tetanus, and whooping cough vaccines.

Babies and Children

Babies need 3 shots of DTaP to build up high levels of protection against

diphtheria, tetanus, and whooping cough. Then, young children need 2
booster shots to maintain that protection through early childhood. CDC
recommends shots at the following ages:

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

For children who should not get whooping cough vaccines, healthcare
professionals can give DT instead of DTaP. For example, children who had a
very bad reaction to DTaP can receive DT. However, children who get DT will
not receive any protection against whooping cough.

Tdap Vaccine for Preteen and Teens

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This fact sheet answers general questions about the booster shot that protects
preteens and teens.

Preteens and Teens

Preteens should get one shot of Tdap between the ages of 11 and 12 years to
boost their immunity. Teens who didn’t get Tdap as a preteen should get one
shot the next time they visit their healthcare professional..

Pregnant Women

Pregnant women should get Tdap during the early part of the 3rd trimester
of every pregnancy. By doing so, she helps protect her baby from whooping
cough in the first few months of life. Find out more about the Tdap
pregnancy recommendation.

Adults
All adults who have never received one should get a shot of Tdap. This can be
given at any time, regardless of when they last got Td. This should be
followed by either a Td or Tdap shot every 10 years.

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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.

A healthcare professional has diagnosed your child 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.

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 has a more serious illness, they should probably
wait until they recover. Your child’s healthcare professional can advise
you.

Your child is 7 years or older.

● Healthcare professionals should not give DT 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.

A healthcare professional has diagnosed your child 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 your child:
○ Had severe pain or swelling after any vaccine containing tetanus
or diphtheria.
○ Ever had a condition called Guillian-Barré Syndrome.
● Some of the following children should not get another dose of DTaP,
but may get DT. 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 has a more serious illness, they should probably
wait until they recover. Your child’s healthcare professional can advise
you.

Your child is 7 years or older.

● Healthcare professionals should not give DTaP 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 a

healthcare professional has diagnosed you or your child 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.

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 have a more serious illness should probably wait
until they recover. Your or your child’s healthcare professional can
advise you.

Your child is younger than 7 years old.

● Healthcare professionals should not give Td 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.

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 have a more serious illness should probably wait
until they recover. Your or your child’s healthcare professional can
advise you.

Your child is younger than 7 years old.

● Healthcare professionals should not give Tdap 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 contains 2 or more vaccines in a single shot in order
to decrease the number of shots given.
The Food and Drug Administration licensed 12 combination vaccines for use
in the United States to help protect against diphtheria and tetanus. Nine of
these vaccines also help protect against whooping cough. Some of the
vaccines include protection against other diseases as well, including polio,
Haemophilus influenzae type b disease, and hepatitis B.
 ● DT (generic) and Td (Tenivac® and generic) provide protection against
diphtheria and tetanus.
● DTaP (Daptacel®, Infanrix®, Kinrix®, Pediarix®, Pentacel®, Quadracel®,
and Vaxelis™) 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 mean the vaccine has full-strength

doses of that part of the vaccine. The lower-case “d” and “p” in Td and Tdap
means these vaccines use smaller doses of diphtheria and whooping cough.
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
bacteria.

DT and Td Vaccines

● DT Generic
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● : Doctors give this vaccine in a 5-shot series to babies and children 6
weeks through 6 years old. Doctors only use this vaccine for children
who should not get whooping cough vaccines.
● Td Generic
● external icon
● : Doctors give this vaccine every 10 years as a booster shot to people 7
years or older. Doctors may also give it as part of a 3-shot series to
people 7 years or older who have not previously gotten any tetanus
and diphtheria vaccines. Doctors may also use this vaccine to complete
the childhood vaccine series for tetanus and diphtheria in people 7
years or older.
● Tenivac®
● external icon
 ● : Doctors give this vaccine every 10 years as a booster shot to people 7
years or older. Doctors may also give it as part of a 3-shot series to
people 7 years or older who have not previously gotten any tetanus
and diphtheria vaccines. Doctors may also use this vaccine to complete
the childhood vaccine series for tetanus and diphtheria in people 7
years or older.

Tdap Vaccines

● Adacel®
● external icon
● : Doctors give a single shot to preteens and teens, as well as adults who
need it. Doctors give a shot to pregnant women during each
pregnancy. Doctors also give it as part of a 3-shot series to people 7
years or older who have not previously gotten any tetanus, diphtheria,
and whooping cough vaccines. Doctors may also use this vaccine to
complete the childhood vaccine series for tetanus, diphtheria, and
whooping cough in people 7 years or older. Doctors may use this
vaccine in place of a Td vaccine every 10 years as a booster shot to
people 7 years or older.
● Boostrix®
● external icon
● : Doctors give a single shot to preteens and teens, as well as adults who
need it. Doctors give a shot to pregnant women during each
pregnancy. Doctors also give it as part of a 3-shot series to people 7
years or older who have not previously gotten any tetanus, diphtheria,
and whooping cough vaccines. Doctors may also use this vaccine to
complete the childhood vaccine series for tetanus, diphtheria, and
whooping cough in people 7 years or older. Doctors may use this
vaccine in place of a Td vaccine every 10 years as a booster shot to
people 7 years or older.

DTaP Vaccines
● Daptacel®
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● : Doctors use this vaccine for all 5 shots in the DTaP vaccine series in
babies and children 6 weeks through 6 years old.
● Infanrix®
● external icon
● : Doctors use this vaccine for all 5 shots in the DTaP vaccine series in
babies and children 6 weeks through 6 years old.
● Kinrix®
● external icon
● : Doctors use this vaccine as the fifth shot in the DTaP vaccine series in
children 4 through 6 years old. It also gives protection against polio.
● Pediarix®
● external icon
● : Doctors use this vaccine for the first 3 shots in the DTaP vaccine series
in babies and children 6 weeks through 4 years old. It also gives
protection against polio and hepatitis B.
● Pentacel®
● external icon
● : Doctors use this vaccine for the first 4 shots in the DTaP vaccine series
in babies and children 6 weeks through 4 years old. It also gives
protection against polio and invasive disease caused by Haemophilus
influenzae type b.
● Quadracel®
● external icon
● : Doctors use this vaccine as the fifth shot in the DTaP vaccine series in
children 4 through 6 years old. It also gives protection against polio.
● Vaxelis™
● external icon
● : Doctors use this vaccine for the first 3 shots in the DTaP vaccine series
in babies and children 6 weeks through less than 1 year old. It also
 gives protection against polio, hepatitis B, and invasive disease caused
by Haemophilus influenzae type b.

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How Well Do These Vaccines Work?

Summary

Vaccines that help protect against diphtheria, tetanus, and whooping cough
differ in how well they work against each disease.

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

● Nearly everyone (95 in 100) against diphtheria for approximately 10

years.
● Almost everyone against tetanus for approximately 10 years.

In studies showing how well the whooping cough component works for
children who get all five doses, DTaP fully protects:

● Nearly all children (98 in 100) within the year following the last dose.
● About 7 in 10 children five years after getting the last dose of DTaP.

In studies showing how well the whooping cough component works, Tdap
fully protects:

● About 7 in 10 people in the first year after getting it.

● About 3 or 4 in 10 people four years after getting it.

In studies showing how well the whooping cough component works when
women get Tdap during pregnancy, the vaccine protects:
 ● More than 3 in 4 babies younger than 2 months old from getting
whooping cough.
● About 9 in 10 babies from whooping cough infections serious enough
to need treatment in a hospital.

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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. Since 2010,
3 cases of diphtheria in the Unites States were reported to CDC. However,
the disease continues to play a role globally. In 2018, countries reported
more than 16,600 cases to the World Health Organization, but many more
cases likely go unreported.

Studies estimate that diphtheria toxoid-containing vaccines protect nearly all

people (95 in 100) for approximately 10 years. Protection decreases over
time, so adults need to get a Td or Tdap booster shot every 10 years to stay
protected.

Tetanus

The United States introduced the first tetanus-toxoid containing vaccine into
the routine childhood immunization schedule in the late 1940s. At that time,
states reported between 500 and 600 cases each year. Tetanus infections
steadily declined after the vaccination recommendation. Today, tetanus is
uncommon in the United States, with an average of 30 reported cases each
year. Nearly all cases of tetanus today are in people who never got a tetanus
vaccine or did not receive a complete course of tetanus vaccines, or adults
who didn’t stay up to date on their 10-year booster shots.

Studies estimate that tetanus toxoid-containing vaccines protect essentially

all people for approximately 10 years. Protection decreases over time, so
adults need to get a Td or Tdap booster shot every 10 years to stay
protected.

Whooping Cough

Whooping cough vaccines became widely available in the 1940s. Before then,
about 200,000 children got sick and about 9,000 died from whooping cough
each year in the United States. After vaccine introduction, whooping cough
cases reached an all-time low in the 1970s. Since then, there has been a slow
but steady increase in reported whooping cough cases. There are several
reasons likely contributing to this increase:

● Increased awareness
● Improved diagnostic tests
● Better reporting
● More spread (circulation) of the bacteria
● Waning immunity (when a vaccine does not provide long-lasting
protection) from current vaccines

The bacteria that cause pertussis are also always changing at a genetic level.
Research is underway to determine if any of the changes are having an
impact on public health. However, the latest studies suggest that pertussis
vaccines continue to be effective despite recent genetic changes.

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
Compared to the vaccine the United States used in the past (known as DTP),
DTaP does not protect against whooping cough for as long. In the 1990s, the
United States switched from whole cell to acellular whooping cough vaccines
for babies and children. Acellular whooping cough vaccines have fewer side
effects, but do not appear to protect for as long.

In general, DTaP is effective for 8 or 9 in 10 children who get it. Among

children who get all 5 shots of DTaP on schedule, effectiveness is very high.
The vaccine protects nearly all children (98 in 100) within the year following
the last shot. About 7 in 10 kids are fully protected 5 years after getting their
last shot of DTaP. The other 3 in 10 kids are partially protected and are less
likely to have serious disease if they do get whooping cough.

In the first year after getting the vaccine, Tdap protects about 7 in 10 people.
There is a decrease in effectiveness in each following year. The vaccine fully
protects about 3 or 4 in 10 people 4 years after getting Tdap.

A CDC evaluation found Tdap vaccination during the third trimester of

pregnancy prevents more than 3 in 4 cases of whooping cough in babies
younger than 2 months old. For babies who do get whooping cough, 9 in 10
are protected from infections serious enough to need treatment in a hospital
if their mother received Tdap during pregnancy.

Learn more about DTaP waning immunity and whooping cough outbreaks.

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What Are the Possible Side Effects?

Most people who get a vaccine that helps protect against diphtheria, tetanus,
and whooping cough 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 possible.

Mild Problems

DT Vaccine

Mild problems following DT vaccination can include:

● Reactions where the healthcare professional gave the shot

○ Redness
○ Swelling
○ Soreness or tenderness
● Fever
● Loss of appetite
● Vomiting

DTaP Vaccine

Mild problems following DTaP vaccination can include:

● Reactions where the healthcare professional gave the shot

○ Redness
○ Swelling
○ Soreness or tenderness
● Fever
● Fussiness (irritability)
● Feeling tired
● Loss of appetite
● Vomiting

Reactions where the healthcare professional gave the shot and fever occur
more often after the fourth and fifth doses of the DTaP series than after
earlier doses. Sometimes the entire arm or leg that the shot was given in
swells after the fourth or fifth dose. If this happens, the swelling lasts
between 1 and 7 days.
Td Vaccine

Mild problems following Td vaccination can include:

● Reactions where the healthcare professional gave the shot

○ Pain
○ Redness
○ Swelling
● Fever
● Headache
● Feeling tired

Tdap Vaccine

Mild problems following Tdap vaccination can include:

● Reactions where the healthcare professional gave the shot

○ 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 after receiving a
vaccine can help prevent fainting, and injuries caused by a fall. Tell your
healthcare professional if you or your child:
 ○ Feels dizzy
○ Has vision changes
○ Has ringing in the ears
● Some people get severe pain in the shoulder and have difficulty moving
the arm where the healthcare professional gave the shot. This happens
very rarely.
● Any medicine can cause severe allergic reactions. Such reactions from
a vaccine are very rare, estimated at about 1 in a million doses. These
types of reactions 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’s office 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, they are regularly available for children at:

● Pediatric offices
● Family practice offices
● Community health clinics
● Public health departments
If your healthcare professional does not have these vaccines for adults, ask
for a referral.

These vaccines may also be available for adults at:

● Pharmacies
● Workplaces
● Community health clinics
● Health departments
● 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 Can I Get Help Paying for These Vaccines?

There are several ways to cover the cost of diphtheria, tetanus, and
whooping cough vaccines:

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

Most health insurance plans cover routine vaccinations. The Vaccines for
Children(VFC) program also provides vaccines for children 18 years and
younger who are uninsured, underinsured, Medicaid-eligible, American
Indian, or Alaska Native.

References

● Skoff TH, Blain, AE, Watt J, et al. Impact of the US maternal tetanus,
diphtheria, and acellular pertussis vaccination program on preventing
pertussis in infants <2 months of age: A case-control evaluation
● external icon
● . Clin Infect Dis. 2017;65(12):1977–83.
● Acosta AM, DeBolt C, Tasslimi A, et al. Tdap vaccine effectiveness in
adolescents during the 2012 Washington state pertussis epidemic
● external icon
● . Pediatrics. 2015;135:981–9.
● Misegades LK, Winter K, Harriman K, at al. Association of childhood
pertussis with receipt of 5 doses of pertussis vaccine by time since last
vaccine dose, California, 2010
● external icon
● . JAMA. 2012;308:2126–32.
● Tartof SY, Lewis M, Kenyon C, et al. Waning immunity to pertussis
following 5 doses of DTaP
● external icon
● . Pediatrics. 2013;131:e1047–52.
● Tiwari TSP, Wharton M. Diphtheria toxoid. In Plotkin SA, Orenstein WA,
Offit, PA, Edwards KM, eds. Vaccines. 7th ed. China: Saunders,
2018:261–75.
● Roper MH, Wassilak SGF, Scobie HM, Ridpath AD, Orenstein WA.
Tetanus toxoid. In: Plotkin SA, Orenstein WA, Offit PA, Edwards KM,
eds. Vaccines. 7th ed. China: Saunders, 2018:1052–79.