TdVax Discontinuation: What Providers and Prescribers Need to Know in 2026

The permanent discontinuation of TdVax (MassBiologics/Grifols) in 2024 fundamentally changed the U.S. Td vaccine landscape. With only Sanofi Pasteur's Tenivac remaining as the sole Td-only option — and Tenivac subject to ongoing CDC ordering controls — providers need a clear clinical protocol for navigating tetanus and diphtheria vaccination in 2026. This guide provides a comprehensive overview for physicians, nurse practitioners, physician assistants, and pharmacists.

Clinical Context: What Was Lost When TdVax Was Discontinued

TdVax (Tetanus and Diphtheria Toxoids, Adsorbed, MassBiologics) contained 2 Lf tetanus toxoid and 2 Lf diphtheria toxoid per 0.5 mL dose. It was FDA-approved for active immunization in persons ≥7 years of age and was one of only two Td vaccines licensed in the United States. Its discontinuation in early 2024 — with supply exhaustion by June 2024 — left Tenivac as the sole Td-only option.

The downstream effects have been significant: increased demand on Tenivac, CDC ordering controls, and elevated demand for Tdap vaccines (Adacel, Boostrix) as substitutes — contributing to localized spot shortages of Tdap products that persisted through 2025 and into 2026.

CDC Guidance: When to Use Tdap vs. Td in 2026

The CDC's ACIP guidance, updated in response to TdVax's discontinuation, recommends:

• Routine adult boosters (every 10 years): Tdap (Adacel or Boostrix) is preferred over Td for patients without a contraindication to the pertussis component. This has been ACIP's preference for years; TdVax's discontinuation makes it even more operationally relevant.
• Wound management: Tdap can substitute for Td in wound prophylaxis for patients without a pertussis contraindication. For patients who have received Tdap previously, a Td-only booster (Tenivac) may be preferred when the wound indication arises within 2 years of prior Tdap, to avoid excessive pertussis antigen exposure.
• Contraindication to pertussis component: Reserve remaining Tenivac supply for patients with a documented contraindication to the acellular pertussis component — most critically, those with a history of encephalopathy (coma, prolonged seizures) within 7 days of a prior pertussis-containing vaccine, and those with severe allergic reactions to any Tdap component.
• Pregnancy: ACIP recommends Tdap during every pregnancy (gestational weeks 27–36), regardless of prior Tdap receipt. Td-only vaccines are not preferred in pregnancy without a pertussis contraindication.

Who Truly Needs Tenivac (Td-Only) in 2026?

Given the constrained Tenivac supply, providers should prioritize Tenivac for the following patient populations:

1. Patients with a history of encephalopathy (coma, decreased consciousness, or prolonged seizures) within 7 days of a prior pertussis-containing vaccine — this is a contraindication per ACIP
2. Patients with a severe allergic reaction (anaphylaxis) to a pertussis-containing vaccine component
3. Patients for whom the prescribing provider has documented a clinical reason to avoid the pertussis component

For all other patients — including those who simply "prefer" Td to avoid the extra pertussis antigen — the clinical rationale for preserving limited Tenivac supply for contraindicated patients should be communicated clearly.

Managing Vaccine Inventory and Procurement in 2026

For practices and clinics that routinely stock and administer Td vaccines, several operational adaptations are now necessary:

• Shift default orders to Tdap. If your practice previously stocked TdVax as the default Td vaccine, update your vaccine formulary to Adacel or Boostrix as the primary option, with Tenivac reserved for documented contraindicated patients.
• Work with your vaccine distributor on Tenivac ordering. Given CDC ordering controls, contact your primary vaccine distributor (McKesson, Cardinal Health, AmerisourceBergen, or state public health supply) to understand current Tenivac availability and your ordering limits.
• Document contraindications in the chart. Clearly document which patients have a contraindication to pertussis-containing vaccines so they can be consistently directed to Tenivac, and so other providers in your network are aware.
• Help patients find Tenivac using external tools. If your practice doesn't stock Tenivac and a patient needs it, directing them to resources that can locate it at nearby pharmacies saves valuable clinical time.

Counseling Patients on the TdVax Discontinuation

Some patients may be distressed to learn that the vaccine they've received for years is no longer available. Key counseling points:

• TdVax is permanently discontinued — this is not a temporary shortage, and supply will not resume
• Tdap vaccines provide at minimum the same protection as TdVax, with the additional benefit of pertussis coverage — this is clinically superior for most patients
• For patients with contraindications: acknowledge the added difficulty of locating Tenivac and assist them in finding it
• The most important public health message: do not delay or skip tetanus vaccination because of the TdVax situation — remaining unvaccinated is far more dangerous than receiving an alternative vaccine

Resources for Providers

For practices that need to help patients locate Tenivac or Tdap vaccines, medfinder for providers is a resource that calls pharmacies on a patient's behalf to locate available stock — reducing the burden on both patients and clinical staff.

For step-by-step guidance on helping your patients navigate this situation, see: How to Help Your Patients Find Td Vaccine in Stock: A Provider's Guide.