Available vaccines: DT and Td (Tenivac) protect against diphtheria and tetanus, DTaP (Daptacel, Infanrix, Kinrix, Pediarix, Pentacel, Quadracel) protects against diphtheria, tetanus, and whooping cough, Tdap (Adacel, Boostrix) protects against tetanus, diphtheria, and whooping cough.

[Upper-case letters indicate full-strength doses of diphtheria (D), tetanus (T) toxoids, and whooping cough (P). Lower-case “d” and “p” indicate reduced doses of diphtheria and whooping cough. The “a” stands for “acellular,” denoting the whooping cough component contains only parts of the bacteria instead of the whole cell.]


Tetanus is caused by the Clostridium tetani bacteria. Spores of tetanus are located throughout the environment, and the disease does not spread from person to person. Instead, the bacteria are found in soil, dust, and manure and enter the body through breaks in the skin or wounds caused by contaminated objects. The tetanus spores develop into bacteria once inside the body and cause illness. The most common ways to introduce the tetanus spores into the body include wounds contaminated dirt, feces, saliva, or other bodily fluids, puncture wounds, burns, crush injuries, or injuries resulting in dead tissue. Tetanus has an incubation period of 3 to 21 days, and shorter incubation periods are indicative of a more serious disease and worse prognosis.

Symptoms of tetanus include jaw cramping (this disease is often referred to as lock jaw), muscle spasms, stiffness, seizures, trouble swallowing, headache, fever and sweating, fluctuations in blood pressure, and tachycardia. Complications of tetanus include laryngospasm, broken bones, pulmonary embolism, pneumonia and other secondary infections, and difficulty breathing.

Tetanus Vaccine

Prior to the vaccine, 500 to 600 cases were reported each year in the United States. Currently, the only reported cases of tetanus are in individuals who do not receive the vaccine or who do not stay up to date on the 10-year booster shots.

Tetanus-toxoid vaccines protect almost all people for approximately 10 years. Over time, the protection decreases, requiring adults to receive a Td booster shot every 10 years.


Diphtheria is an infection caused by Corynebacterium diphtheria bacteria. It is transmitted most commonly via respiratory droplets, although it is possible to contract the illness from touching open sores or clothes that have touched open sores of someone with diphtheria. Diphtheria bacteria attach to the lining of the respiratory tract and release toxins that destroys healthy tissues. Within 2 to 3 days, an infected individual can develop a pseudomembrane over dead tissue in the nose, tonsils, and throat, making it difficult to breath and swallow. In severe cases, the toxins may enter the blood stream and cause myocarditis, polyneuropathy, and paralysis. With treatment, the mortality rate for diphtheria is one in 10, and without treatment, one out of two patients can die.

Diphtheria Vaccine

In 1921, the United States had 206,000 cases of diphtheria with 15,520 reported deaths. The vaccine became available in the 1920s, and many countries started widely vaccinating. In the past decade, there were less than five cases in the United States reported to the CDC.

Diphtheria toxoid containing vaccines protect approximately 95 out of 100 individuals for approximately 10 years. Adults need to receive a Td booster every 10 years to remain protected.

Whooping Cough

Whooping cough (pertussis) is a highly contagious respiratory disease caused by the bacteria Bordetella pertussis. The bacteria attach to the cilia in the upper respiratory tract and release toxins, which cause damage to the cilia resulting in inflammation of the airway. Pertussis is an airborne illness spread from coughing, sneezing, or being in close vicinity to one another. Infected individuals become most contagious approximately 2 weeks after the cough develops; prescription antibiotics may shorten the duration a person remains contagious.

Pertussis starts with cold-like symptoms (mild cough, fever, runny nose) and, as the disease progresses, the traditional symptoms of pertussis appear, including paroxysms or rapid coughs followed by a “whoop” sound, vomiting during or after coughing fits, and exhaustion from coughing fits. The coughing fits worsen as the illness continues and can be extremely dangerous in infants causing episodes of apnea. Coughing fits can be so severe that it is not unusual for adults and young adults to fracture their ribs. As individuals begin to recover from pertussis, they are still at an increased risk of secondary respiratory infections.

Pertussis is a serious diagnosis in infants and young children: many will develop complications, and there is even a risk of death. As many as one-quarter of infants or young children with pertussis will develop pneumonia despite hospitalization and there is also a risk of convulsions and encephalopathy.

Although antibiotics are available to treat pertussis, by the time individuals seek medical attention (often after the coughing begins) antibiotics are unlikely to help because the bacteria have already released their toxic effects.

Whooping Cough Vaccine

Prior to vaccine availability in the 1940s, whooping cough caused approximately 200,000 cases each year in the United States, resulting in approximately 9,000 deaths annually.

After the full series of DTaP on schedule, 98 out of 100 children are fully protected against whooping cough within the year following the last dose and seven out of 10 children are protected against whooping cough 5 years after receiving last dose of DTaP.

Tdap fully protects seven out of 10 people from whooping cough in the first year after receiving it and approximately four out of every 10 people are fully protected against whooping cough 4 years after receiving the vaccine.

Who Should Get the Vaccine?

Per the CDC, all babies, children, preteens, teens, and pregnant women should receive the vaccine. DTaP is indicated for babies and children younger than 7 years, and Tdap is indicated for older children and adults. Other adults should get one dose of the Td vaccine every 10 years, and adults who need protection from whooping cough can receive Tdap at any time.

Who Should Not Get the Vaccine?

Children should not receive DT if they are allergic to any component of the vaccine, if they are sick with a moderate to severe illness, or if the child is over 7 years. Prior to immunization, it should be discussed with the child’s healthcare provider if they have seizures or other nervous system problems or ever had Guillian-Barré syndrome.

Children should not receive DTaP if they had a seizure or collapsed, suffered a brain or nervous system disease within 7 days, cried nonstop for 3 or more hours, or had a fever of over 105F after a previous dose of DTaP. If a child is moderately to severely ill, they should not receive the vaccine. DTaP should not be given to anyone over the age of 7 years.

Td and Tdap should not be administered to anyone with an allergy to any ingredient in the vaccine or if there was a previous allergic reaction to the vaccine. Anyone who is moderately to severely ill should not receive the vaccine, and it should not be administered to individuals younger than age 7 years.

Side Effects

DT can result in mild injection-site reactions (redness, swelling, tenderness), fever, loss of appetite, and vomiting.

DTaP can cause mild injection-site reactions, fever, fussiness, tiredness, loss of appetite, and vomiting.

Td may cause injection-site reactions, fever, headache, and tiredness.
Tdap can cause injection-site reactions, fever, headache, tiredness, nausea, vomiting, diarrhea, stomach ache, chills, and body aches.

Some people may have pain and difficulty moving the arm where the shot was given. Injection-site reactions should resolve in 1 to 7 days postinoculation.

Insurance Coverage

Medicare part D covers the Tdap; however, specific plans may require a copay or partial payment.

Most private health insurances cover the vaccines.

The Vaccines for Children Program may be able to help those who do not have health insurance coverage for their child or if their insurances does not cover vaccines.