New evidence suggests that adults may not need routine tetanus and diphtheria booster shots after all, potentially saving the U.S. around $1 billion annually.
The protection from childhood vaccinations appears to last for decades, matching findings from the U.K., where boosters haven’t been given since the 1950s, yet disease rates remain extremely low.
Potential Billion-Dollar Savings
A new review led by scientists at Oregon Health & Science University suggests the United States could safely eliminate routine tetanus and diphtheria booster shots for adults and save roughly $1 billion every year.
The researchers stressed that these savings and safety depend on keeping childhood vaccination rates consistently high.
“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., professor of microbiology and immunology in the OHSU School of Medicine and the Oregon National Primate Research Center. “That would save $1 billion a year in the U.S. while maintaining the safety and protection of the general population.”
Slifka added that ending the 10-year booster schedule would bring U.S. practices more in line with recommendations from the World Health Organization.
Decades of Immunity Confirmed
The review builds on earlier OHSU studies published in 2016 and 2020, which found that the combined tetanus and diphtheria vaccine provides immunity lasting at least 30 years. That protection far exceeds the current guidance from the U.S. Centers for Disease Control and Prevention, which advises adults to receive a booster every 10 years. The vaccine is most often administered as the combination shot for tetanus, diphtheria, and pertussis, known as DTaP.
In the United States, children are scheduled to receive six doses of this vaccine between infancy and age 12.
According to the review, eliminating routine adult boosters would be safe as long as childhood vaccination coverage remains strong. Boosters could still be given in specific situations, such as after serious injuries like workplace accidents or car crashes, where tetanus exposure is a concern.
Natural Experiment in Europe
Published recently in the journal Clinical Microbiology Reviews, the review highlights a comparison between two industrialized countries just 21 miles across the English Channel: France and the United Kingdom. Both countries have 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.
“The question we asked is, ‘What happens if we don’t vaccinate the adults? Are there more cases of disease or are these people protected after completing their childhood vaccination series?’”
France vs. United Kingdom Outcomes
Similar to the United States, France has a recommended booster vaccination schedule for adults. In contrast, except during pregnancy or for wound management, the United Kingdom hasn’t recommended boosters for tetanus and diphtheria beyond age 14 since the 1950s.
Yet, despite decades of adult booster vaccination, the review found that France had virtually no advantage over the U.K. in the rates of tetanus or diphtheria. In fact, the review found that the UK had a slightly lower rate overall.
Herd Immunity Holds Strong
In addition, “herd immunity” held strong even in 2022 when the U.K. reported an outbreak of 73 imported diphtheria cases among immigrants seeking asylum. This spike in cases was almost equal to the total number of diphtheria cases reported in the entire country over the previous 20 years combined.
“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 U.K. Health Security Agency concluded that the country’s current childhood-focused vaccination program is sufficient for preventing the spread of diphtheria and that the risk to the general UK population remains low.
Vaccines’ Life-Saving Impact
The findings highlight the remarkable durability of protection following childhood vaccination against a pair of diseases that were once all but a death sentence.
In 1948, the U.S. mortality rate for tetanus was 91%. Before the introduction of antibiotics and vaccines, the mortality rate for diphtheria was roughly 50%. To this day, diphtheria kills roughly one out of 10 people who aren’t vaccinated against it.
Childhood Vaccinations Keep Us Safe
Today, the public health threat is diminished thanks to childhood vaccinations as well as booster shots recommended in pregnancy.
“Thanks to childhood vaccinations, these diseases are incredibly rare,” Slifka said. “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.”
Reference: “Lessons learned from successful implementation of tetanus and diphtheria vaccination programs” by Mark K. Slifka, Archana Thomas, Lina Gao, Ian J. Amanna and Walter A. Orenstein, 15 July 2025, Clinical Microbiology Reviews.
DOI: 10.1128/cmr.00031-25
In addition to Slifka, 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.
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