Administering Diphtheria, Tetanus, and Pertussis Vaccines

This page provides a brief summary of guidance for administering diphtheria, tetanus, and pertussis vaccines, including route, number of doses, and co-administration with other vaccines.

Visual Inspection

Do not use any diphtheria, tetanus, and pertussis vaccine or diluent (if applicable) beyond the expiration date printed on the label.

Prior to administration, visually inspect the vaccine for particulate matter and/or discoloration. If these conditions exist, do NOT use.

Just before use, shake vial or manufacturer-filled syringe well. Do not use vaccine if you cannot resuspend it after thorough agitation.

• After shaking, Td should be a cloudy, whitish-gray colored liquid.
• After shaking, Tdap should be a cloudy, white-colored liquid.

Administer all diphtheria, tetanus, and pertussis vaccines (DTaP, Td, and Tdap) by the intramuscular route.

Infants and young children: The preferred injection site is the vastus lateralis muscle of the thigh.

Older children and adults: The preferred injection site is the deltoid muscle in the upper arm.

Use a needle length appropriate for the age and size of the person receiving the vaccine.

Number and Timing of Doses

The number and timing of doses depends on the type of vaccine used and the person receiving the vaccine.

Infants and young children

CDC recommends DTaP for all infants and children younger than 7 years of age. If the pertussis component is contraindicated, use Td to complete the primary series in this age group.

• The recommended DTaP series is 5 doses, administered at 2, 4, and 6 months, 15 through 18 months, and 4 through 6 years.
• Administer the fourth dose of DTaP no earlier than 6 months after the third dose. However, you do not need to repeat the fourth dose if it was administered at least four months after the third dose.
• Do not administer the fourth dose of DTaP to children younger than 12 months of age. You can give it to children at 12 through 15 months of age if the child is unlikely to return at 15 through 18 months of age; this is an off-label recommendation from the Advisory Committee on Immunization Practices.
• The fifth dose of DTaP is not necessary if the patient received the fourth dose on or after their fourth birthday.

Older children and adults

CDC recommends 1 dose of Tdap for all adolescents.

• The preferred age for Tdap administration in adolescents is 11 to 12 years.
• If adolescents (13 through 18 years) missed getting Tdap at 11 to 12 years of age, administer at the next patient encounter or sooner if adolescent will have close contact with infants.
• You can administer Tdap regardless of interval since the last tetanus toxoid- and diphtheria toxoid-containing vaccine.

CDC recommends 1 dose of Tdap for women during each pregnancy.

• The preferred timing for Tdap administration in pregnancy is during the early part of gestational weeks 27 through 36.
• You can safely administer Tdap earlier in pregnancy if it is indicated for wound care or during a community pertussis outbreak. If you administer Tdap earlier in pregnancy, do not repeat vaccination between 27 and 36 weeks gestation; CDC recommends only one dose during each pregnancy.
• You can administer Tdap regardless of interval since the last tetanus toxoid- and diphtheria toxoid- containing vaccine.
• Do not offer Tdap as part of routine preconception care.
• CDC only recommends Tdap in the immediate postpartum period for new mothers who did not receive Tdap during their current pregnancy and did not receive a prior dose of Tdap (i.e., during adolescence, adulthood, or a previous pregnancy). If a woman did not receive Tdap during her current pregnancy but did receive a prior dose of Tdap, then she should not receive a dose of Tdap postpartum.

CDC recommends 1 dose of Tdap for healthcare personnel who have never received Tdap and who have direct patient contact.

• You can administer Tdap regardless of interval since the last tetanus toxoid- and diphtheria toxoid-containing vaccine.

Adults who have never received Tdap should receive a single dose of Tdap.

• Vaccinate adults as soon as feasible.
• You can administer Tdap regardless of interval since the last tetanus toxoid- and diphtheria toxoid-containing vaccine.

After receipt of Tdap, patients should continue to receive Td or Tdap for routine booster immunization every 10 years.

Predrawing Vaccine Doses

There are no data on the stability of vaccines stored in syringes filled by healthcare personnel. Therefore, CDC does not recommend predrawing vaccine doses.

• Single-dose vials: Draw all of the vaccine into a sterile syringe using a sterile needle at the time of administration. Once you remove the protective cap from a single-dose vial, use the vaccine or discard it at the end of the workday. Single-dose vials do not contain a preservative and it is difficult to tell if a needle has penetrated the rubber stopper.
  • The manufacturer supplies Pentacel® in 2 vials that you must mix together before administration. Unused, reconstituted Pentacel® may be stored in the refrigerator between 2°C and 8°C (36°F and 46°F) for up to 30 minutes.
• Manufacturer-filled syringes: Activate (i.e., remove syringe tip or attach needle) manufacturer-filled syringes when you administer it. Once activated, use a manufacturer-filled syringe that day or discard it at the end of the workday. The sterile seal has been broken.

Administration with Other Vaccines

There are no contraindications to the co-administration of diphtheria, tetanus, and pertussis vaccines. You may administer DTaP, Td, and Tdap with other indicated vaccines during the same visit. However, administer each vaccine using a separate syringe and, if possible, at a different anatomic site. COVID-19 vaccine should be administered in a separate limb, if feasible.

There is a small increased risk of febrile seizures in children 6 through 23 months of age when giving trivalent inactivated influenza vaccine (IIV3) with DTaP according to a Vaccine Safety Datalink study. However, CDC made no changes in the recommendations; you may give these vaccines at the same time.