Adacel Shortage: A Provider's Update for 2026

Healthcare providers across the United States have been navigating vaccine supply challenges since the Td shortage began in 2024. While Adacel (Tdap, Sanofi Pasteur) is not in a formal FDA-listed shortage, intermittent availability issues at pharmacies and clinics have created real barriers to delivering timely immunization to patients.

This article provides a clinical and operational update for physicians, pharmacists, nurse practitioners, and other prescribers managing Tdap vaccination in the current supply environment. For tools to help your patients find vaccines in stock, visit MedFinder for Providers.

Supply Chain Context: Why Adacel Availability Is Strained

The root cause of current Adacel availability challenges is the ongoing Td (tetanus-diphtheria) vaccine shortage:

• March 2024: MassBiologics permanently discontinued TdVax production, removing a major Td source from the U.S. market.
• Mid-2024: The CDC issued guidance recommending Tdap substitution for Td "whenever possible while Td supplies are constrained."
• 2024-Present: Tenivac (Sanofi Pasteur) remains the sole Td product, with limited availability. Demand shifted heavily to Tdap products.
• October 2025: FDA approved repeat Adacel dosing after 8 years, expanding the eligible population.

The net effect: Adacel and Boostrix are absorbing demand previously met by Td vaccines, resulting in intermittent stock-outs at the pharmacy level despite ongoing manufacturing.

Clinical Guidance: Tdap as Td Substitute

CDC Recommendations

The CDC's current position is clear: administer the Tdap vaccine you have available. Key clinical points:

• Either Adacel or Boostrix may be used for any situation where Td would have been given, including wound management tetanus prophylaxis.
• Although Adacel is FDA-approved for ages 10-64 and Boostrix for ages 10+, the CDC advises providers to administer whichever Tdap product is available regardless of age, given the Td shortage.
• For adults 65+: Boostrix is the preferred product, but Adacel administered to patients over 64 is considered valid by the CDC.
• Repeat Tdap dosing is now FDA-approved for Adacel after 8 years, aligning with the updated labeling.

Pregnancy Considerations

Maternal Tdap immunization during weeks 27-36 of gestation remains a critical recommendation. Both Adacel and Boostrix are appropriate for this indication. Given the supply constraints:

• OB-GYN practices should consider stocking Tdap directly rather than relying on pharmacy referrals.
• If one Tdap product is unavailable, administer the other without delay.
• Document the specific product administered in the patient's immunization record.

Wound Management

For tetanus-prone wound management when Td is unavailable:

• Administer Tdap (Adacel or Boostrix) regardless of the patient's prior Tdap history.
• If no Tdap is available and the wound is tetanus-prone, administer Tetanus Immune Globulin (TIG) for passive immunization and arrange Tdap follow-up as soon as possible.
• Document the clinical decision and supply limitation in the patient's chart.

Operational Strategies for Managing Supply

Inventory Management

• Diversify distributors: If your practice or pharmacy uses a single distributor, consider establishing relationships with secondary wholesalers.
• Maintain safety stock: Adjust par levels upward for Tdap given the elevated demand.
• Monitor CDC and ASHP updates: Subscribe to the ASHP Drug Shortage Resource Center for real-time shortage notifications.
• Coordinate with local health departments: Public health agencies may have separate supply channels and can sometimes assist with emergency vaccine allocation.

Patient Flow and Triage

When Tdap supply is limited, consider prioritizing allocation:

1. Highest priority: Pregnant patients (weeks 27-36), wound management requiring tetanus prophylaxis
2. High priority: Healthcare workers with employer requirements, close contacts of infants under 12 months
3. Standard priority: Routine adolescent boosters, routine adult boosters

Communicate proactively with patients about potential availability issues and offer to place them on callback lists when stock is expected.

Using MedFinder for Provider Referrals

MedFinder for Providers allows clinicians and staff to quickly search for pharmacies with Adacel or Boostrix in stock near the patient's location. This is particularly useful for:

• Practices that don't stock vaccines on-site and need to direct patients to pharmacies
• Emergency departments sending patients for outpatient vaccination follow-up
• Cases where your usual pharmacy source is temporarily out of stock

Documentation and Coding

Proper documentation during the shortage is important for both clinical and billing purposes:

• Record the specific product administered (Adacel vs. Boostrix) including lot number and manufacturer.
• Note when Tdap is given as a Td substitute and reference CDC guidance in the clinical note.
• Billing codes: CPT 90715 for Tdap vaccine, CPT 90471 for immunization administration (first vaccine), CPT 90472 for each additional vaccine administered at the same visit.
• If a vaccine was unavailable and patient was deferred, document the shortage and plan for follow-up.

Patient Communication Templates

Consider using standardized messaging for common patient questions:

When Adacel Is Out of Stock

"We're currently experiencing a supply delay for the Adacel vaccine due to nationwide demand increases. We have [Boostrix/no Tdap] available as an alternative that provides the same protection. We expect to receive more Adacel [estimated date]. Would you like us to schedule you for that time or proceed with [the available alternative]?"

For Pregnant Patients

"Your Tdap booster during pregnancy is important for protecting your baby from whooping cough. While our first-choice vaccine may not be available today, we have [Boostrix] which provides the same protection. I recommend we proceed with vaccination today rather than delay."

Alternative Sourcing Strategies

When standard distribution channels can't meet demand:

• CDC's Vaccines for Children (VFC) program: Eligible adolescents can receive vaccines through this program at participating providers.
• State immunization programs: Some states maintain emergency vaccine reserves.
• Manufacturer direct: Contact Sanofi Pasteur's customer service (1-800-822-2463) for supply assistance.
• Regional vaccine sharing: Coordinate with nearby practices or health systems that may have excess supply.

Looking Ahead

The Adacel availability situation is expected to gradually improve through 2026 as:

• Sanofi Pasteur scales production capacity for both Adacel and Tenivac
• Distribution patterns normalize to reflect sustained higher Tdap demand
• Pharmacy ordering systems adjust par levels

However, providers should plan for continued intermittent supply variability. Building operational resilience — diverse sourcing, appropriate safety stock, and patient communication protocols — will serve your practice well beyond this specific shortage.

For more patient-facing information you can share, see our patient guide to the Adacel shortage. For tools to help your patients locate vaccines, visit MedFinder for Providers.