20 July, 2025
us-researchers-advocate-ending-adult-tetanus-diphtheria-boosters

The United States could safely eliminate tetanus and diphtheria booster shots for adults, potentially saving an estimated $1 billion annually, according to a new review led by researchers at Oregon Health & Science University (OHSU). The study emphasizes that this cost-saving measure hinges on maintaining robust childhood vaccination rates.

“By maintaining high childhood vaccination coverage, we not only protect kids, but we may actually be able to reduce adult booster vaccinations,” said lead author Mark Slifka, Ph.D., a professor of microbiology and immunology at OHSU. “That would save $1 billion a year in the U.S. while maintaining the safety and protection of the general population.”

Aligning with Global Guidelines

Slifka noted that discontinuing the 10-year schedule for adult boosters would align more closely with guidelines recommended by the World Health Organization. This review supports previous OHSU research from 2016 and 2020, which concluded that the combined vaccine provides at least 30 years of immunity, far exceeding the current U.S. Centers for Disease Control and Prevention (CDC) recommendation for adult boosters every 10 years. The vaccine is typically administered as a combined tetanus, diphtheria, and pertussis vaccine, known as DTaP.

In the U.S., childhood vaccinations are recommended six times, from infancy through age 12. The new review suggests eliminating adult boosters altogether, provided childhood vaccination rates remain high. However, boosters may still be necessary on a case-by-case basis, such as for individuals injured in workplace accidents or car crashes.

A Natural Experiment: France vs. the UK

Published in the journal Clinical Microbiology Reviews, the review draws a comparison between France and the United Kingdom, two industrialized countries with excellent childhood vaccination coverage similar to the U.S. “This represents sort of an experiment of nature,” Slifka said. “We have one country with over 60 million people that for decades has continued to vaccinate adults throughout their lifetime and another nearby country that also has over 60 million people, but over the past 50 years, they have never recommended adult booster vaccinations.”

In France, adult booster vaccinations are recommended, while the UK has not recommended them beyond age 14 since the 1950s, except during pregnancy or for wound management. Despite decades of adult booster vaccinations, the review found that France had virtually no advantage over the UK in tetanus or diphtheria rates. In fact, the UK had a slightly lower rate overall.

“Remarkably, despite this proportionally large influx of imported diphtheria cases, there was no evidence of transmission reported among other asylum seekers who arrived by other routes or among staff or health care workers,” the authors write.

The UK Health Security Agency concluded that the country’s childhood-focused vaccination program is sufficient for preventing the spread of diphtheria, with a low risk to the general population.

Historical Context and Current Implications

The findings emphasize the enduring protection provided by childhood vaccinations against diseases that were once life-threatening. In 1948, the U.S. mortality rate for tetanus was 91%, and before vaccines, the mortality rate for diphtheria was about 50%. Today, diphtheria still kills roughly one in ten unvaccinated individuals.

“Thanks to childhood vaccinations, these diseases are incredibly rare,” Slifka stated. “In fact, you’re 10 to 1,000 times more likely to be struck by lightning than to be diagnosed with tetanus and diphtheria in the United States.”

In addition to Slifka, the study’s co-authors include Archana Thomas and Lina Gao, Ph.D., of OHSU; Ian J. Amanna, Ph.D., of Najít Technologies; and Walter A. Orenstein, M.D., of the Emory Vaccine Center at Emory University.

Research reported in this publication was supported by the Office of the Director of the National Institutes of Health, award number P51OD011092. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

As the debate over adult booster vaccinations continues, this research may influence future public health policies. The potential cost savings and alignment with global practices could prompt a reevaluation of current guidelines, provided the high rates of childhood vaccinations are maintained.