Resolution No. 10/12-1 

ADVISORY COMMITTEE ON IMMUNIZATION PRACTICES 

VACCINES FOR CHILDREN PROGRAM 

VACCINES TO PREVENT DIPHTHERIA, TETANUS AND PERTUSSIS 

The purpose of this resolution is to revise the previous resolution to incorporate new recommendations 

regarding the vaccination of pregnant adolescents. 

VFC resolution 6/11--2 is repealed and replaced by the following: 

Eligible Groups 

Children and adolescents aged 6 weeks through 18 years. 

Recommended Schedule for Diphtheria, Tetanus, and Pertussis Vaccines 

Dose Age

Primary 1 2 months

Primary 2 4 months

Primary 3 6 months

First Booster (1) 15-18 months

Second Booster (2) 4-6 years

Tdap or Td Booster (3) 11-12 years

(1) The first booster dose may be administered as early as age 12 months, provided 6 months have 

elapsed since the third dose. 

(2) The second booster is not necessary before entering kindergarten or elementary school if fourth 

dose is administered on or after the fourth birthday. 

(3) Tdap is preferred over Td as adolescents are susceptible to pertussis due to waning immunity. A 

Tdap or Td booster is recommended at any age from 11 through 18 years if they have 

completed the recommended childhood DTP/DTaP vaccination series and have not received a 

Td dose. In some special situations, Td, rather than Tdap may be indicated (more information is 

available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5503a1.htm?s_cid=rr5503a1_e).

DTaP, DT, Tdap, and Td vaccine formulations 

There are currently two licensed formulations of Tdap for adolescents, BOOSTRIX® and ADACEL®. 

BOOSTRIX® (Tdap) vaccine is indicated for active immunization of persons 10 years and older. 

ADACELTM (Tdap) is indicated for active immunization of persons aged 11 years and older. Td vaccine is 

indicated for active immunization of persons 7 years of age or older for prevention of tetanus and 

diphtheria. For immunization of infants and children younger than 7 years of age against pertussis, tetanus 

and diphtheria, refer to the manufacturers’ package inserts for Diphtheria and Tetanus Toxoids and 

Acellular Pertussis Vaccine Adsorbed (DTaP) or combination vaccines containing DTaP and for 

Diphtheria and Tetanus Toxoids Adsorbed (For Pediatric Use) (DT). Use diphtheria and tetanus toxoids, 

adsorbed (DT or Td) if encephalopathy has occurred after administration of a previous dose of pertussis-
containing vaccine. The use of brand names is not meant to preclude the use of other comparable licensed 

vaccines. 

Dosage Intervals for 

Vaccination for 

Diphtheria, Tetanus, 

and Pertussis 

Containing Vaccines 

Vaccine 

Minimum 

Age 

Minimum interval between doses 

Dose 1 to 2 Dose 2 to 3 Dose 3 to 4 Dose 4 to 5 

DTaP 6 weeks 4 weeks 4 weeks 6 months 6 months (1)

DTaP-HepB-IPV(2) 6 weeks 4 weeks 4 weeks

DTaP-Hib-IPV(3) 6 weeks 4 weeks 4 weeks 6 months

DT 6 weeks 4 weeks 4 weeks 6 months 6 months (1)

DTaP-Hib(4) 15-18 months 6 months

DTaP-IPV(5) 4 years 6 months (1)

Tdap/Td(6) 11 years

Tdap/Td Catch –up 

schedule(7)

7 years 4 weeks 6 months 5 years║ -------

Note: DT containing vaccines are not indicated for children older than 6 years of age. 

(1) The fifth dose is not necessary if the fourth dose was given after the fourth birthday. 

(2) The combined DTaP-HepB-IPV vaccine may be used when any component of the 

combination is indicated, and if the other components are not contraindicated. The 

combined DTaP-HepB-IPV vaccine is approved for the primary series only (Doses 1-3). 

For adequate immune response, the last dose of hepatitis B vaccine should be given at ≥24 

weeks of age and therefore this combination vaccine should not be administered as a 

complete primary series on an accelerated schedule at 4 week intervals for prevention of 

pertussis. 

(3) The combined DTaP-Hib-IPV vaccine may be used when any component of the combination 

is indicated, and if the other components are not contraindicated. The combined DTaP-HibIPV vaccine is approved for the primary series and first booster dose (Doses 1-4). The 

combined DTaP-Hib-IPV vaccine is not indicated for children 5 years of age and older. 

(4) The combined DTaP/Haemophilus influenzae type b (Hib) vaccine is only indicated for the 

fourth dose at age 15 through 18 months. 

(5) The combined DTaP-IPV vaccine may be used when any component of the combination is 

indicated, and if the other components are not contraindicated. The combined DTaP-IPV 

vaccine is approved for the booster dose at age 4 through 6 years. 

(6) Tdap is indicated for a single booster dose at age 11 or 12 years if the childhood DTP/DTaP 

vaccination series has been completed. Tdap is preferred over Td as adolescents are 

susceptible to pertussis due to waning immunity, though Td may be indicated rather than 
Tdap in special situations (more information is available at: 

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5503a1.htm?s_cid=rr5503a1_e). Adolescents 

who did not receive Tdap at age 11 or 12 should receive a single dose of Tdap in place of a 

single Td booster dose. Tdap can be administered regardless of interval since the last tetanus 

or diphtheria containing vaccine. 

(7) Adolescents who are pregnant should receive Tdap, irrespective of past history of Tdap 

receipt. If not administered during pregnancy, Tdap should be administered immediately 

postpartum. 

(8) Tdap should be given to children 7 through 18 years of age who have received tetanus and 

diphtheria containing vaccines (DT or Td) instead of DTP/DTaP for some or all doses of 

the childhood series; have received fewer than 5 doses of DTP/DTaP or 4 doses if the 

fourth dose was administered at age 4 years or older; or have never been vaccinated against 

tetanus, diphtheria, or pertussis (no doses of pediatric DTP/DTaP/DT or Td). The preferred 

schedule is a single Tdap dose, followed by a dose of Td four weeks after the first dose and 

a second dose of Td 6-12 months later. If not administered as the first dose, Tdap can be 

substituted for any of the other Td doses in the series. More information about the catch-up 

is available in Appendix D at: 

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5503a1.htm?s_cid=rr5503a1_e. Of note, this 

appendix which was designed to provide catch up guidance for adolescents aged 11 through 18 

years, now applies to children aged 7 through 18 years. Tdap is preferred over Td as adolescents 

are susceptible to pertussis due to waning immunity, though Td may be indicated rather 

than Tdap in special situations (more information is available at: 

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5503a1.htm?s_cid=rr5503a1_e). 

Recommended Dosages 

Refer to product package inserts. 

Contraindications and Precautions

Contraindications and precautions can be found at: 

• http://www.cdc.gov/mmwr/preview/mmwrhtml/00041645.htm

• http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5503a1.htm?s_cid=rr5503a1_e

[If an ACIP recommendation regarding vaccination to prevent diphtheria, tetanus, and pertussis is 

published within 12 months following this resolution, the relevant language above (except in the 

eligible groups sections) will be replaced with the language in the recommendation and incorporated 

by reference to the publication URL.] 

Adopted and Effective: October 24, 2012 

This document can be found on the CDC website at: 

http://www.cdc.gov/vaccines/programs/vfc/downloads/resolutions/1012-1-dtap.pdf