Advisory No. 23: Updated Recommendations for Use of Tdap Vaccine in Adults 65 Years and Older

Print Version of Vaccine Advisory No. 23 (PDF)

August 17, 2012
Updated Recommendations for Use of Tdap Vaccine in Adults 65 Years and Older

The goal of the Vaccine Advisory is to disseminate, in a timely manner, practical information related to vaccines, vaccine-preventable diseases, and the vaccine programs managed by the Immunizations Unit. The Immunizations Unit welcomes readers’ input to improve the contents of this document.

On February 22, 2012, the Centers for Disease Control and Prevention’s (CDC’s) Advisory Committee on Immunization Practices (ACIP) voted to expand the age for vaccination with tetanus, diphtheria, and acellular pertussis (Tdap) vaccine to include adults age 65 years and older. Previously, the vaccine had only been recommended for adults 65 years and older who were in close contact with an infant less than 12 months of age.

This advisory summarizes the new recommendations which became official on June 29, 2012 and are published in CDC’s Morbidity and Mortality Weekly Report (MMWR).

This advisory contains:

  1. Background information
  2. Summary of ACIP‘s recommendations for Tdap vaccine
  3. Texas Vaccines for Children program
  4. ImmTrac
  5. Texas school and child-care facilities requirements for Tdap vaccine
  6. Epidemiology and surveillance
  7. Reporting vaccine adverse events
  8. Resources

1. Background information

Pertussis is a highly contagious respiratory tract infection. Although most children are protected against pertussis by vaccination during childhood, immunity wanes over time and leaves adolescents and adults unprotected.

Tdap vaccine, first licensed in the U.S. in 2005, is the only product available to protect older children, teens and adults against pertussis. Two Tdap vaccines are currently licensed in the United States. They are Boostrix® (GSK), approved for use in people age 10 years and older, and Adacel® (sanofi pasteur) approved for use in people ages 11 through 64 years.

Pertussis continues to be a major public health problem, with adults being the primary source of infectious transmission to unprotected infants. Consequently, the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices has expanded the indications for the Tdap vaccine.

2. Summary of ACIP's Recommendations for Tdap Vaccine

The updated recommendations state the following:

  • Give a single dose of Tdap to previously unvaccinated adults age 19 years and older.
  • Give the Tdap dose regardless of the interval since the person last received a tetanus or diphtheria toxoid-containing vaccine.
  • Give the Tdap dose to adults for whom it is recommended if no record of previous administration exists.
  • Providers should not miss an opportunity to give Tdap to people age 65 years and older. Administer the vaccine you have available—either Boostrix® or Adacel®. When feasible, give Boostrix® to adults age 65 years and older. However, either vaccine product provides protection and is considered valid for use in people in this age group.

    Texas Vaccines for Children Program

    The TVFC program follows the ACIP recommendations for the use of Tdap vaccine for eligible children through 18 years of age.

    For questions or information, please contact your health service region, or TVFC consultant.


    ImmTrac users can report administration of Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis (Tdap) vaccine using CPT code 90715. For more information about ImmTrac, please refer to:

    Texas School and Child-Care Facilities Requirements for Tdap Vaccine

    In 2009, the state of Texas adopted new Tdap immunization requirements:

    • 7th grade students – All students entering 7th grade are required to have one dose of Tdap vaccine if at least 5 years have passed since their last dose of a tetanus-diphtheria-containing vaccine.
    • 8th through 12th grade students – Students in grades 8-12 are required to have a booster dose of Tdap if it has been 10 years since their last dose of tetanus-diphtheria-containing vaccine. Td is acceptable in place of Tdap if a medical contraindication to pertussis exists.

    Tdap is also required for students enrolled in health- related courses in institutions of higher education. Please refer to the Texas Administrative Code §97.64

    More information about required vaccinations can be found at on the DSHS school immunizations program website.

    Epidemiology and Surveillance

    Pertussis, or whooping cough, is an acute, highly infectious, toxin-mediated disease caused by the bacterium Bordetella pertussis. Disease in adolescents and adults may be milder and go undetected in these individuals. They are still capable of transmitting the disease, especially to those most vulnerable, infants. In 2011, 961 cases of pertussis occurred in Texas. The majority of cases occur among infants younger than 1 year of age. Tetanus and diphtheria are also acute, toxin-mediated diseases. Both diseases are rare in the United States but both can be fatal. Diphtheria is spread from person to person and causes a tough membrane to cover the throat, sometimes blocking the airway. Diphtheria has not been reported in Texas for many years, but is still endemic in many other countries. Tetanus is also known as lockjaw because of the rigidity and stiffness that is often seen in the muscles of the jaw, although it can also cause spasms and locking of muscles of any part of the body. Tetanus bacteria are present in the soil and in the intestines and feces of animals. Any wound, even a minor scratch, can be susceptible to tetanus infection. In 2011, 2 cases of tetanus were reported in Texas. Pertussis, tetanus and diphtheria are all reportable conditions in Texas. All suspected cases of diphtheria are to be reported to the health department immediately; pertussis within 1 working day of diagnosis, and tetanus within a week of diagnosis.

    To report cases, please call (800) 705-8868.

    Reporting Vaccine Adverse Events

    An adverse event is a health problem that is reported after someone gets a vaccine or medicine.

    Adverse events from privately purchased vaccine should be reported directly to VAERS. Secure web-based reporting is available on the VAERS website. You may also contact VAERS at (800) 822-7967 for forms and information.

    In Texas, reports of adverse events following vaccination at public health clinics or with vaccine provided through public funding such as the Texas Vaccines for Children (TVFC) program should be reported through the Texas Department of State Health Services, Immunizations Unit via fax or mail:

    1. Fax a completed VAERS Form to:1-866-624-0180 (toll-free)
    2. Mail a completed VAERS form to

      Texas Department of State Health Services
      Immunizations Unit, MC-1946
      P.O. Box 149347
      Austin, TX 78714-9347

    A copy of the form is also available in the TVFC Toolkit. For more information about VAERS, or for a pre-addressed postage-paid VAERS form, you can contact DSHS at (800) 252-9152.


    We hope you generously forward this advisory to others who may benefit from this information.

    Texas Department of State Health Services
    Immunizations Unit
    P.O. Box 149347,
    Austin, Texas, 78714-9347

    Last updated September 21, 2016