Tetanus, diphtheria, and pertussis (whooping cough) are serious bacterial infections. Tetanus causes painful tightening of the muscles, usually all over the body. It can lead to "locking" of the jaw. Diphtheria usually affects the nose and throat. Whooping cough causes uncontrollable coughing. Vaccines can protect you from these diseases. In the U.S., there are four combination vaccines:

• DTaP prevents all three diseases. It is for children younger than seven years old.
• Tdap also prevents all three. It is for older children and adults.
• DT prevents diphtheria and tetanus. It is for children younger than seven who cannot tolerate the pertussis vaccine.
• Td prevents diphtheria and tetanus. It is for older children and adults. It is usually given as a booster dose every 10 years. You may also get it earlier if you get a severe and dirty wound or burn.

Some people should not get these vaccines, including those who have had severe reactions to the shots before. Check with your doctor first if you have seizures, a neurologic problem, or Guillain-Barre syndrome. Also let your doctor know if you don't feel well the day of the shot; you may need to postpone it.

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.

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.

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.

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.

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.

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.

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 (Adaceland 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.

A combination vaccine contains 2 or more vaccines in a single shot in order to decrease the number of shots given.

DT and Td Vaccines

• DT Generic: 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: 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: 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: 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: 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: Doctors use this vaccine for all 5 shots in the DTaP vaccine series in babies and children 6 weeks through 6 years old.
• Infanrix: Doctors use this vaccine for all 5 shots in the DTaP vaccine series in babies and children 6 weeks through 6 years old.
• Kinrix: 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: 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: 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: 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: 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.

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.

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.

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.

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

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.

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.

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.