Contraindications and precautions to diphtheria, tetanus, and pertussis-containing vaccines for children and adolescents age 7 through 18 years

Vaccine	Contraindications	Precautions*
Tdap	Severe allergic reaction (eg, anaphylaxis) after a previous dose or to a vaccine component, including latex^¶ Refer to an allergist to evaluate allergy to tetanus toxoid and possibility of desensitization to tetanus toxoid Encephalopathy (eg, coma, decreased level of consciousness, or prolonged seizure) within 7 days of previous dose of DTwP, DTaP, or Tdap that is not attributable to another identifiable cause	Guillain-Barré syndrome <6 weeks after previous dose of tetanus toxoid-containing vaccine Progressive or unstable neurologic disorder, uncontrolled seizures, or progressive encephalopathy Defer pertussis component until a treatment regimen has been established and the condition has stabilized History of Arthus-type reaction after a previous dose of tetanus or diphtheria toxoid-containing vaccines Defer vaccination until ≥10 years after the last dose of the tetanus toxoid-containing vaccine Moderate or severe acute illness with or without fever
Td	Severe allergic reaction (eg, anaphylaxis) after a previous dose or to a vaccine component, including latex^¶ Refer to an allergist to evaluate allergy to tetanus toxoid and possibility of desensitization to tetanus toxoid	Guillain-Barré syndrome <6 weeks after previous dose of tetanus toxoid-containing vaccine History of Arthus-type reaction after a previous dose of tetanus or diphtheria toxoid-containing vaccines Defer vaccination until ≥10 years after the last dose of the tetanus toxoid-containing vaccine Moderate or severe acute illness with or without fever
Tdap may be given to children with the following conditions that are incorrectly perceived as contraindications or precautions to Tdap
Fever of ≥40.5°C (105°F) for <48 hours after vaccination with a previous dose of DTaP or DTwP History of collapse or shock-like state (ie, hypotonic hyporesponsive episode) within 48 hours after receiving a previous dose of DTaP or DTwP History of seizure with or without fever within 3 days after receiving a previous dose of DTaP or DTwP History of persistent, inconsolable crying lasting >3 hours within 48 hours after receiving a previous dose of DTaP or DTwP History of extensive limb swelling after DTaP, DTwP, or Td that is not an Arthus-type reaction Stable or resolved neurologic disorder, including well-controlled seizures, history of seizure disorder, and cerebral palsy History of brachial neuritis Breastfeeding an infant Immunosuppression

Tdap: tetanus and reduced diphtheria toxoids, and acellular pertussis; DTwP: diphtheria and tetanus toxoids, and whole-cell pertussis; DTaP: diphtheria and tetanus toxoids, and acellular pertussis; Td: tetanus and reduced diphtheria toxoids (adult Td, dT).
* Precautions are conditions that may increase the risk for a serious reaction to immunization, cause diagnostic confusion, or compromise the ability of the vaccine to produce immunity. Although immunization is generally deferred in children and adolescents with precautions, decisions regarding administering diphtheria toxoid, tetanus toxoid, and pertussis-containing vaccines to children with precautions should be individualized according the benefits and risks, and reassessed at subsequent immunization visits.
¶ Information about latex is available in the prescribing information, available from the US Food and Drug Administration.

References:

Liang JL, Tiwari T, Moro P, et al. Prevention of pertussis, tetanus, and diphtheria with vaccines in the United States: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2018; 67:1.
Kroger AT, Bahta L, Hunter P. General best practice guidelines for immunization. Best practices guidance of the Advisory Committee on Immunization Practices (ACIP). Contraindications and precautions. Available at: https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/contraindications.html (Accessed on January 19, 2022).

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Contraindications and precautions to diphtheria, tetanus, and pertussis-containing vaccines for children and adolescents age 7 through 18 years