The DTaP vaccine gets a reserved recommendation. The diseases are real and dangerous, and, in the case of pertussis, very common. In addition, the worst cases of pertussis occur in the youngest infants, which is why we recommend the vaccine starting at the age of two months. Overall, we recommend this vaccine, and it is actually our third choice for children, mainly because of the widespread nature of pertussis in the United States. However, the side effects are real and are not trivial. We completely understand why parents are hesitant to vaccinate with this vaccine.
If parents of young children decline to vaccinate with DTaP, we then recommend the DT vaccine for children under the age of seven. This provides the necessary protection from diphtheria and tetanus without the side effects of the acellular pertussis portion of the vaccine. As already mentioned, the pertussis component is responsible for the majority of the worrisome side effects of the DTaP vaccine, whereas the DT vaccine has minimal side effects. Unfortunately, you also lose the protection from pertussis, which is the more common and potentially more dangerous disease.
The case for Tdap is clearer. Pertussis is a common but mild disease in adolescents and adults. However, they are the people who spread it to infants, who then develop the severe disease. If we were able to vaccinate enough people to short-circuit the transmission of the bacteria (remember herd immunity on page 29?), we could prevent the hospitalizations and deaths in our youngest children. A single booster dose of Tdap could break the cycle. And even though there are many side effects with this vaccine, they are generally mild and never permanent. Thus, we recommend the Tdap vaccine.
we also recommend the Td vaccine. Everyone needs a booster to get protection from diphtheria and tetanus on a regular basis, and the Td vaccine every ten years fits the bill. However, some insurance plans don’t pay for preventative vaccines but will pay for a Td vaccine after an injury. If you have received the primary series of three vaccines, it is unlikely that you will get a significant infection, no matter how deep the wound. And diphtheria is rare in the United States. So if you prefer to wait until you get a significant cut before getting your booster dose so that insurance will pay for the vaccine, that is an acceptable alternative.