Diphtheria, Tetanus, and Pertussis (DTaP)

Diphtheria, Tetanus, and Pertussis (DTaP)

March 21, 2017

Diphtheria, Tetanus, and Pertussis (DTaP)

What are diphtheria, tetanus, and pertussis?

Diphtheria, pertussis, and tetanus are serious diseases.

  • Diphtheria. Diphtheria is a serious bacterial disease that can infect the body in two areas:

    • The throat (respiratory diphtheria)

    • The skin (skin or cutaneous diphtheria)

    The diphtheria bacterium can enter the body through the nose and mouth. It can also enter through a break in the skin. It is transmitted from person-to-person by fluids from the lungs, nose, throat and mouth, or droplets in the air. After being exposed to the bacteria, it usually takes 2 to 4 days for symptoms to develop. It can lead to breathing problems, paralysis, heart failure, and even death.

  • Tetanus. Tetanus (lockjaw) is an serious, often fatal, disease of the central nervous system. It is caused by the toxin of the tetanus bacterium, which usually enters the body through an open wound. Tetanus causes painful tightening of the muscles, usually all over the body. It can lead to "locking" of the jaw so the person cannot open his or her mouth or swallow.

    Tetanus is not contagious. It occurs in people who have had a skin or deep tissue wound or puncture. It is also seen in the umbilical stump of infants in underdeveloped countries. This occurs in places where immunization to tetanus is not widespread and women may not know proper care of the umbilical stump after the baby is born. After being exposed to tetanus, it may take between 2 days to 2 months to develop any symptoms. In infants, symptoms may take between 5 days to 2 weeks to develop.

  • Pertussis. Pertussis, or whooping cough, mainly affects infants and young children. It is caused by a bacterium called Bordetella pertussis. Pertussis causes intense fits or spells (paroxysms) of coughing that end with the characteristic whoop as air is inhaled. Whooping cough causes coughing spells so bad that it is hard for infants and children to eat, drink, or breathe. These spells can last for weeks. In infants, it may cause periods of apnea (not breathing).

    It is spread from person to person through droplets in the air (coughing and sneezing), and is highly contagious. Once the bacterium is in the child's airways, swelling of the airways and mucus production starts. It can lead to pneumonia, seizures, brain damage, and death.

Immunization against diphtheria, tetanus, and pertussis

Diphtheria, tetanus, and pertussis vaccines prevent these diseases. Most children who get all of their shots will be protected during childhood. A combination vaccine is given to babies and children and provides protection against all three diseases. There are several types of the vaccine:

  • DTaP vaccine:

    • Protects against diphtheria, tetanus, and pertussis

    • Newer form of the vaccine, in which the pertussis component is "acellular," thus less likely to cause reactions than former types

  • DT or Td boosters:

    • Protects against diphtheria and tetanus

    • For people 7 years of age and older

    • Recommended every 10 years for adults

  • Tdap vaccine: 

    • Protects against tetanus, diphtheria, and pertussis 

    • Recommended as a booster shot for adolescents ages 11 to 18 years who have completed the recommended DTaP series and as a one-time booster for adults in place of their next every-ten-year booster shot. It should also be given as a booster after a penetrating injury if the last booster was more than 5 years ago.

When are diphtheria, tetanus, and pertussis combination vaccines given?

DTaP vaccine is given in 5 doses to babies and children at the following ages:

  • 2 months

  • 4 months

  • 6 months

  • 15 to 18 months

  • 4 to 6 years

Your child also needs a booster dose called the Tdap vaccine at ages 11 through 12 years. If your child is older than that, the Tdap should replace the next tetanus and diphtheria (Td) booster. The Td booster should then be given every 10 years throughout life.

Some children should not get the DTaP vaccines, or should get them at a later date. Other children may get the vaccines only after consulting with a healthcare provider. These include children who:

  • Previously had a moderate or serious reaction after getting vaccinated

  • Previously had a seizure or collapsed after a dose of DTaP

  • Cried nonstop for 3 hours or more after a dose of DTaP

  • Had a fever over 105°F (41°C) after a dose of DTaP

  • Had brain or nervous system problems after a previous vaccine 

  • Currently have a moderate or severe illness

Your child's healthcare provider will advise you about vaccines in these situations.

What are the risks from DTaP vaccines?

As with any medicine, vaccines carry a small risk of serious harm, such as a severe allergic reaction or even death. If there are reactions, they usually start within 3 days and do not last long. Most people have no serious reactions from these vaccines. Reactions are much less likely after DTaP than older forms of the vaccine. Common reactions to these vaccines may include:

  • Soreness at the injection site 

  • Fussiness

  • Fatigue

  • Fever

  • Decreased appetite

  • Vomiting

Severe reactions such as very high fever, seizures, or allergic reactions to these vaccines are rare.

How do I care for my child after immunization with DTaP vaccine?

  • Give your child aspirin-free pain reliever for 24 hours after the shot, or as directed by your child's healthcare provider. 

  • Watch for signs of reaction, such as high fever, behavior change, seizure, or difficulty breathing. Report these or any other unusual signs right away to your child's healthcare provider.


March 21, 2017


Baker, Carol J., MD, FAAP; RED BOOK Atlas of Pediatric Infectious Diseases- Diphtheria (2013) 2nd, Baker, Carol J., MD, FAAP; RED BOOK Atlas of Pediatric Infectious Diseases- Tetanus (2013) 2nd, Diptheria, tetanus toxoids, and acellular pertusis vaccine: Drug information, Up To Date, Prymula, R. Effect of Prophylactic Paracetamol Administration at Time of Vaccination on Febrile Reactions and Antibody Responses in Children: Two Open-Label, Randomised Controlled Trials. Lancet (2009) 374;9698 pp 1339-1350

Reviewed By:  

Freeborn, Donna, PhD, CNM, FNP,Lentnek, Arnold, MD