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Diphtheria and Tetanus Toxoids

Medically reviewed by Drugs.com. Last updated on Jun 11, 2020.

Pronunciation

(dif THEER ee a & TET a nus TOKS oyds)

Index Terms

  • Diphtheria
  • DT
  • Td
  • Tetanus
  • Tetanus and Diphtheria

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

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]

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)

Brand Names: U.S.

  • TDVax
  • Tenivac

Pharmacologic Category

  • Vaccine
  • Vaccine, Inactivated (Bacterial)

Pharmacology

Promotes active immunity to diphtheria and tetanus by inducing production of specific antibodies.

Use: Labeled Indications

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) (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.

Contraindications

Hypersensitivity to diphtheria, tetanus toxoid, or any component of the formulation

Dosing: Adult

Note: Immunization during coronavirus disease 2019 (COVID-19) pandemic: Routine vaccination should NOT be delayed because of the COVID-19 pandemic (CDC 2020; WHO 2020). In general, simultaneous administration of all vaccines for which a patient is eligible (according to current immunization schedules/guidelines) is recommended (ACIP [Ezeanolue 2020]). However, outpatient visits solely for vaccination should be delayed in persons in quarantine due to close contact with COVID-19 or persons who have suspected or confirmed COVID-19 infection (regardless of symptoms); refer to the CDC's "Interim Guidance for Immunization Services During the COVID-19 Pandemic" for current recommendations (https://www.cdc.gov/vaccines/pandemic-guidance/index.html). Additional information is available from the American Academy of Pediatrics and the Immunization Action Coalition.

Booster immunization (Td): 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): 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.

Tetanus Prophylaxis in Wound Management

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 ≤6 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 ≤6 years of age); DTaP = diphtheria and tetanus toxoids, and acellular pertussis (formulation for ≤6 years of age; Daptacel, Infanrix); Td = diphtheria and tetanus toxoids (formulation for ≥7 years of age; 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

Dosing: Geriatric

Refer to adult dosing.

Dosing: Pediatric

Note: Immunization during coronavirus disease 2019 (COVID-19) pandemic: Routine vaccination should NOT be delayed because of the COVID-19 pandemic (CDC 2020; WHO 2020). In general, simultaneous administration of all vaccines for which a patient is eligible (according to current immunization schedules/guidelines) is recommended (ACIP [Ezeanolue 2020]). However, outpatient visits solely for vaccination should be delayed in persons in quarantine due to close contact with COVID-19 or persons who have suspected or confirmed COVID-19 infection (regardless of symptoms); refer to the CDC's "Interim Guidance for Immunization Services During the COVID-19 Pandemic" for current recommendations (https://www.cdc.gov/vaccines/pandemic-guidance/index.html). Additional information is available from the American Academy of Pediatrics and the Immunization Action Coalition.

Note: 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. According to ACIP, doses administered ≤4 days before minimum interval or age are considered valid; however, local or state mandates may supersede this timeframe (ACIP [Ezeanolue 2020]).

Primary immunization:

CDC (ACIP) recommendations (CDC/ACIP [Liang 2018]): Infants and Children 6 weeks through <7 years with contraindication to pertussis-containing vaccines: 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, 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: 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.

Tetanus Prophylaxis Wound Management

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 ≤6 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.

3Yes, if ≥10 years since last dose.

4Yes, if ≥ 5 years since last dose.

5For 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 age ≤6 years); DTaP = Diphtheria and Tetanus Toxoids, and Acellular Pertussis (formulation for age ≤6 years; Daptacel, Infanrix); Td = Diphtheria and Tetanus Toxoids (formulation for age ≥7 years; 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

Administration

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 [Ezeanolue 2020]). 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: Administer in the deltoid muscle; do not inject in the gluteal area

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 [Ezeanolue 2020]).

Storage

Store at 2°C to 8°C (35°F to 46°F). Do not freeze; discard if product has been frozen.

Drug Interactions

Fingolimod: May diminish the therapeutic effect of Vaccines (Inactivated). 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. Consider therapy modification

Immunosuppressants: May diminish the therapeutic effect of Vaccines (Inactivated). Management: Complete all age-appropriate vaccinations at least 2 weeks prior to starting an immunosuppressant. If vaccinated less than 2 weeks before starting or during immunosuppressant therapy, revaccinate at least 3 months after immunosuppressant discontinuation. 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. Consider therapy modification

Siponimod: May diminish the therapeutic effect of Vaccines (Inactivated). Management: Avoid administration of vaccines (inactivated) during treatment with siponimod and for 1 month after discontinuation due to potential decreased vaccine efficacy. Consider therapy modification

Venetoclax: May diminish the therapeutic effect of Vaccines (Inactivated). Monitor therapy

Adverse Reactions

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

Warnings/Precautions

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 [Ezeanolue 2020]).

• 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 [Ezeanolue 2020]).

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. Defer 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 [Ezeanolue 2020]).

• 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 [Ezeanolue 2020]).

• 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 [Ezeanolue 2020]).

• 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 inactivated) for which a person is eligible at a single clinic 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 [Ezeanolue 2020]).

Special populations:

• Altered immunocompetence: Consider deferring immunization during periods of severe immunosuppression (eg, patients receiving chemo/radiation therapy or other immunosuppressive therapy [including high-dose corticosteroids]); may have a reduced response to vaccination. In general, household and close contacts of persons with altered immunocompetence may receive all age-appropriate vaccines. Inactivated vaccines should be administered ≥2 weeks prior to planned immunosuppression when feasible; inactivated vaccines administered during chemotherapy should be readministered after immune competence is regained (ACIP [Ezeanolue 2020]; 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 [Ezeanolue 2020]).

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 [Ezeanolue 2020]). 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. Vaccines may not be effective if administered during periods of altered immune competence (ACIP [Ezeanolue 2020]).

Monitoring Parameters

Monitor for anaphylaxis and syncope for 15 minutes following administration (ACIP [Ezeanolue 2020]). If seizure-like activity associated with syncope occurs, maintain patient in supine or Trendelenburg position to reestablish adequate cerebral perfusion.

Pregnancy Considerations

In general, maternal use of inactivated vaccines is not associated with increased risks to the fetus (ACIP [Ezeanolue 2020]). 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]).

Patient Education

What is this drug used for?

• It is used to prevent tetanus and diphtheria.

All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away:

• Headache

• Injection site pain, redness, or swelling

• Loss of strength and energy

• Joint pain

• Joint swelling

• Nausea

• Diarrhea

• Mild fever

• Abnormal crying (children)

• Lack of appetite (children)

WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:

• Severe dizziness

• Passing out

• Muscle pain

• Muscle weakness

• Face muscle weakness

• Uneven smile

• Burning or numbness feeling

• Abnormal movements

• Severe injection site irritation

• Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.

Note: This is not a comprehensive list of all side effects. Talk to your doctor if you have questions.

Consumer Information Use and Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a limited summary of general information about the medicine’s uses from the patient education leaflet and is not intended to be comprehensive. This limited summary does NOT include all information available about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not intended to provide medical advice, diagnosis or treatment and does not replace information you receive from the healthcare provider. For a more detailed summary of information about the risks and benefits of using this medicine, please speak with your healthcare provider and review the entire patient education leaflet.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.