# Tetanus, Diphtheria & Pertussis Canonical page: https://carecard.ca/knowledge/immunizations-serology/tetanus-diphtheria-pertussis **Status:** Required for all students **Valid for:** The adult Tdap dose is a one-time booster; a tetanus/diphtheria (Td) booster is then recommended every 10 years. This page explains why proof of a tetanus, diphtheria and pertussis vaccine is required and how it works, using guidance from Health Canada and the Public Health Agency of Canada. It is educational and does not replace advice from your own health care provider or the specific rules of your program and placement site. See the [Source & references](#source--references) at the bottom. ## Why this is required [#why-this-is-required] Placement sites require proof that you are protected against the vaccine-preventable diseases you could encounter — or pass on — during patient care. A single **Tdap** shot covers three of them at once: tetanus, diphtheria and pertussis (whooping cough). * **Protects you.** Tetanus can enter through any contaminated wound, and diphtheria and pertussis spread in clinical settings — the vaccine gives you lasting protection. * **Protects your patients.** Pertussis is most dangerous to newborns too young to be fully vaccinated. Being immunised lowers the chance you pass it to a vulnerable infant or patient. * **It is usually already started.** These vaccines are part of routine childhood immunization in Canada, so most students only need a one-time adult booster and their existing records. Health Canada recommends that **all adults receive one dose of Tdap** if they have not already had a pertussis-containing vaccine in adulthood, followed by a tetanus–diphtheria (Td) booster every 10 years. ## About the three diseases [#about-the-three-diseases] * **Tetanus (lockjaw)** is caused by a neurotoxin from the bacterium *Clostridium tetani*, whose spores live in soil and enter the body through a wound contaminated with soil, dust or faeces. It is **not spread person to person**, but it is serious: the case-fatality rate in unvaccinated people ranges from 10% to over 80%, and is highest in infants and older adults. * **Diphtheria** is caused by toxin-producing *Corynebacterium diphtheriae* and spreads person to person from the respiratory tract. The toxin can cause systemic complications such as myocarditis and nervous-system effects, with a case-fatality rate of about 5% to 10%, highest in the very young and the elderly. * **Pertussis (whooping cough)** is a highly communicable bacterial illness spread by respiratory droplets. It is most severe in infants too young to be fully vaccinated, in whom it can cause pneumonia, seizures, encephalopathy and death. ## How the vaccine works [#how-the-vaccine-works] **Tdap** combines two toxoids (inactivated tetanus and diphtheria toxins) with acellular pertussis components. None of these can cause the diseases; they teach your immune system to neutralise the toxins and recognise the pertussis bacterium. It is given as a combination shot — the adult booster is often **Tdap-IPV** when polio protection is also needed — so one injection can cover several diseases at once. ## How well it works [#how-well-it-works] * After a complete primary series, more than **97%** of people develop antibody levels that protect against diphtheria, and protective tetanus antitoxin develops in virtually everyone; tetanus in someone whose last dose was within 10 years is extremely rare. * The pertussis component is estimated to be about **85%** effective after the primary series, but protection against pertussis declines over time — which is why boosters and vaccination in pregnancy matter. ## Safety and side effects [#safety-and-side-effects] Reactions are usually **mild and short-lived**: * Redness, swelling and pain at the injection site — the most common reactions * In adults, headache and fatigue are also common Serious adverse events are rare following a tetanus, diphtheria or pertussis vaccine. ## Staying protected [#staying-protected] The adult **Tdap dose is a one-time booster** if you have not had a pertussis-containing vaccine as an adult. After that, a **tetanus–diphtheria (Td) booster is recommended every 10 years** (or sooner for certain wounds). Health Canada also recommends a Tdap dose in **every pregnancy**, ideally between 27 and 32 weeks, to protect the newborn. Confirm what applies to you with your program or a health care provider. ## What to submit [#what-to-submit] * A record showing your adult **Tdap** dose (tetanus, diphtheria, pertussis), **or** your completed childhood series plus your most recent booster * The vaccine name and the date of each relevant dose * Your full legal name and date of birth on every document ## Accepted proof [#accepted-proof] * Childhood immunization record (e.g. the yellow immunization card) * Provincial or public health immunization record * Pharmacy or clinic immunization receipt showing Tdap, Td or Tdap-IPV * International immunization card with an English translation ## Good to know [#good-to-know] * Combination vaccines count: doses listed as DTaP-IPV, Tdap, Td or Tdap-IPV all include tetanus and diphtheria (and, where "aP"/"ap" appears, pertussis). * Many programs specifically want proof of a **Tdap** dose in adulthood, not just a tetanus booster — check which one your site requires. * If your last tetanus/diphtheria booster was more than 10 years ago, you will likely need an updated dose before placement. ## Validity [#validity] The adult Tdap dose is a one-time booster; a tetanus/diphtheria (Td) booster is then recommended every 10 years. ## Source & references [#source--references] The medical information on this page is adapted from Health Canada and the Public Health Agency of Canada: * [Health Canada](https://www.canada.ca/en/health-canada.html) * [Pertussis (whooping cough) vaccines: Canadian Immunization Guide](https://www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-part-4-active-vaccines/page-15-pertussis-vaccine.html) * [Tetanus toxoid: Canadian Immunization Guide](https://www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-part-4-active-vaccines/page-22-tetanus-toxoid.html) * [Diphtheria toxoid: Canadian Immunization Guide](https://www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-part-4-active-vaccines/page-4-diphtheria-toxoid.html) * [Immunization of workers: Canadian Immunization Guide](https://www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-part-3-vaccination-specific-populations/page-11-immunization-workers.html)