Tenivac Shortage: What Providers and Prescribers Need to Know in 2026

The 2024 discontinuation of TdVax by MassBiologics permanently altered the Td vaccine landscape in the United States. As of 2026, Tenivac by Sanofi Pasteur remains the sole FDA-approved Td (tetanus and diphtheria toxoids) vaccine available in the US market. This guide provides a clinical summary for providers navigating supply constraints, patient communication challenges, and sourcing strategies.

Background: How the Td Market Changed in 2024

Prior to 2024, two Td vaccines were available in the US: Tenivac (Sanofi Pasteur, NDC 49281-0215-15/10) and TdVax (MassBiologics, distributed by Grifols USA). In early 2024, MassBiologics announced permanent discontinuation of TdVax production, citing declining demand as more providers transitioned to Tdap products. Grifols indicated remaining TdVax stocks would run out by approximately June 2024.

In response, the CDC issued guidance in February/March 2024 recommending that providers:

Transition to Tdap vaccines (Adacel, Boostrix) as the default for routine tetanus immunization whenever possible.

Reserve Tenivac supply for patients with documented contraindications to pertussis-containing vaccines.

Observe temporary ordering limits in both the public and private sectors.

Current CDC Recommendations for Td vs. Tdap Substitution

The CDC ACIP position is unambiguous: Tdap is an acceptable alternative to Td for all standard indications, including:

Routine booster immunization (every 10 years) for patients ages 10 and older

Wound management tetanus prophylaxis in previously vaccinated patients

Catch-up immunization for underimmunized patients ages 10 and older

Post-exposure diphtheria prophylaxis (when Td is otherwise indicated)

Note: Tdap vaccines (Adacel and Boostrix) are FDA-approved starting at age 10. For patients ages 7–9 who need Td immunization, Tenivac remains the appropriate vaccine, as no Tdap product is approved for this age range.

When Tenivac Cannot Be Substituted: Pertussis Contraindications

Td-only vaccination is required for patients with the following pertussis vaccine contraindications:

Encephalopathy (contraindication): Documented encephalopathy not attributable to another cause within 7 days of administration of a pertussis-containing vaccine.

Severe allergic reaction (contraindication): Anaphylaxis or severe allergic reaction after a prior dose of Tdap — though this warrants evaluation to identify whether Td components may be tolerated.

Precautions (not absolute contraindications, but warrant clinical judgment) include:

Progressive or unstable neurological disorder

Guillain-Barré syndrome within 6 weeks of a prior tetanus toxoid-containing vaccine

Arthus-type hypersensitivity reactions after prior tetanus toxoid — do not vaccinate more often than every 10 years

Adacel vs. Boostrix: Which Tdap for Which Patient?

Adacel (Sanofi Pasteur): Approved for ages 10–64. Standard choice for routine booster in adults and adolescents.

Boostrix (GSK): Approved for ages 10 and older, including adults 65+. Preferred for pregnant women (gestational weeks 27–36 per ACIP). Also appropriate for wound prophylaxis in any patient 10+.

Sourcing Tenivac for Your Practice

If you have patients who require Tenivac specifically, these sourcing strategies may help:

Distributor contacts: Work directly with McKesson, AmerisourceBergen, or Cardinal Health to check real-time Tenivac availability and set up allocation orders.

VFC program: If you are a VFC provider, contact your state immunization program to check VFC-specific Tenivac availability for eligible patients.

Sanofi direct: Large practices and health systems can contact Sanofi's hospital and institution sales team for direct allocation requests.

medfinder for patients: When your clinic is out of stock but a patient needs Tenivac, direct them to medfinder.com/providers to help find available pharmacies near them.

Documentation and Workflow Considerations

When administering Tdap in place of Tenivac, document the substitution in the patient's chart including: the clinical reason for substitution, any discussed contraindication review, the product used (manufacturer, lot number, expiration date), and the route and anatomical site. This supports continuity of care if the patient is seen by a different provider in the future.

Learn how medfinder supports providers in helping patients locate hard-to-find vaccines at medfinder.com/providers.