Tetanus and Diphtheria Booster Recommendations Under Review

For decades, adults in the U.S. have been advised to get a tetanus and diphtheria booster every ten years. However, new research from Oregon Health & Science University (OHSU) suggests this long-standing guideline might be outdated and potentially unnecessary.

A recent study published by OHSU researchers claims that adults who have completed their childhood vaccinations might not require these boosters as frequently as once thought. The findings imply that immunity from these vaccines could last longer—possibly 30 years or even for life—for most healthy adults.

Dr. Mark K. Slifka, the lead author and professor at OHSU’s Oregon National Primate Research Center, questioned the necessity of giving boosters every decade. He remarked, “Why keep vaccinating adults every 10 years? It’s just burned into our brains when the evidence shows you don’t have to.”

The U.S. has recommended a ten-year booster schedule for tetanus and diphtheria since the 1960s, yet, Slifka noted that this advice has not aligned with the increasing evidence indicating that immunity to these diseases—now quite rare in the U.S. due to widespread childhood vaccinations—does not necessitate such frequent boosters.

He highlighted, “Tetanus and diphtheria are among our most successful vaccines. Their effectiveness has virtually eliminated these diseases in countries with high childhood vaccination coverage.”

Currently, tetanus, a serious bacterial disease often associated with soil and dust exposure, has an incidence rate of less than one case per 10 million people annually in the U.S. Diphtheria is even rarer, with just seven cases reported nationwide in the last two decades.

The last instance of tetanus in Oregon took place in 2017, when an unvaccinated 6-year-old boy nearly died from a scrape. Before that, the state had gone 30 years without a case.

Slifka’s study builds on nearly twenty years of research examining immunity trends in individuals and populations. The results indicate that immunity for adults who received the five-dose series during childhood might last a lifetime, making regular boosters largely unnecessary.

The researchers suggest a more straightforward vaccination schedule: a booster at ages 30 and 60. This could alleviate the confusion surrounding the need to remember when the last shot was received.

Slifka noted that this isn’t an extreme change, as similar practices exist in other countries. For instance, the United Kingdom does not recommend routine adult boosters but has maintained low rates of both diseases, even during a recent spike in diphtheria cases.

Additionally, in 2017, the World Health Organization ceased its recommendation for routine adult boosters, suggesting them only for specific situations like pregnancy, travel, or treating wounds.

Despite this, over 18 million Americans still receive these boosters every year, costing more than $1 billion. The researchers estimate that switching to a 30-year booster schedule could cut vaccination costs by two-thirds, resulting in approximately $280 million in savings annually.

Slifka emphasized that cutting out unnecessary boosters—while still vaccinating pregnant women, those with wounds, and individuals uncertain about their vaccination history—could free up resources for other public health initiatives.

“If we could redirect some of these savings toward addressing vaccine hesitancy and enhancing vaccine education, then I think we could really use that money effectively,” he remarked.

While the study suggests boosters may not be needed as frequently, Slifka insists this shouldn’t detract from the importance of childhood vaccinations. “Vaccines work, and they last a long time,” he said. “By maintaining robust childhood vaccination programs, we can reduce or eliminate the need for adult boosters.”

Any changes to official guidelines would need to go through a review by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices, the body responsible for vaccine policy in the U.S. Slifka hopes this new evidence prompts a reconsideration of the current recommendations.

“The wheels of science turn slowly,” he stated. “But we believe it’s time to bring this topic back into discussion.”