According to a study led by a team from Oregon Health & Science University, US adults might safely skip tetanus and diphtheria booster shots, as long as childhood vaccination rates remain high. This research was published recently in Clinical Microbiology Reviews.
The researchers estimate that eliminating the 10-year boosters could save about $1 billion annually. They compared the impact of the tetanus and diphtheria vaccination programs to other routine childhood vaccines, evaluated vaccination strategies in France and England, and suggested changes to the adult booster schedule.
Diphtheria is indeed contagious, but the population is largely protected due to childhood vaccinations. As noted by the authors, “Tetanus is unique among vaccine-preventable diseases because it is not passed from person to person; hence, vaccination offers individual protection but doesn’t affect community risk.”
‘More likely to be struck by lightning’
The existing vaccination schedule in the US recommends that children receive five doses of the Tdap (which covers diphtheria, tetanus, and whooping cough) by age 7, then one dose for adolescents between 11 and 12, and a booster for adults every decade. Currently, childhood vaccination coverage stands at about 95%.
Despite lacking today’s technological advancements, these vaccines are among the most successful ever created.
Childhood vaccinations against tetanus and diphtheria have led to reductions of about 95% and 99.9%, respectively, mirroring the effectiveness rates of other typical childhood vaccines, including measles, mumps, and rubella, according to the researchers.
The authors highlighted that despite the limitations of past medical technologies, these interventions have dramatically reduced disease incidence, with fewer than one case of tetanus per 10 million person-years and about one case of diphtheria per 1 billion person-years in the US.
Mark Slifka, PhD, noted that the success of childhood vaccination means that both tetanus and diphtheria are now “incredibly rare” in the US. He pointed out, “You’re actually 10 to 1,000 times more likely to get struck by lightning than to be diagnosed with tetanus or diphtheria here.”
Closer alignment with WHO guidelines
France’s approach resembles that of the US in recommending booster vaccines for adults. In contrast, the UK has not recommended adult boosters for anyone over 14 since the 1950s, except for pregnant women and those with wounds at risk for tetanus.
The findings suggest that once the childhood vaccination series is completed, regular booster shots may not be necessary for maintaining immunity in the general public.
Interestingly, investigators found the UK had a slightly lower rate of infections, showing that community immunity was still robust despite a 2022 outbreak of 73 diphtheria cases among asylum seekers.
Despite this influx, no transmission was reported among other asylum seekers or health workers, which is quite remarkable, the authors remarked.
However, they do advise that adult boosters should still be considered for emergency situations, like susceptible wounds, pregnant women, travelers to areas where diphtheria is more common, and individuals who haven’t completed the childhood vaccination series.
The overall conclusion indicates that after finishing the childhood vaccination schedule, regular adult boosters may no longer be essential for the majority, which could help bring US guidelines in line with those of the World Health Organization (WHO). The WHO has not recommended adult boosters for tetanus or diphtheria since 2017.
