Tetanus and diphtheria (tetanus/diphtheria) infections are rare in the United States (U.S.), but adequate vaccination is essential to prevent disease and associated morbidity and mortality. Compared with U.S.-born persons, immigrant and refugee adults have lower completion rates for tetanus/diphtheria vaccination series. However, most electronic health record (EHR)-generated recommendations only advise tetanus/diphtheria vaccines every 10 years for persons ≥ 18 years. This analysis compared documented completion of tetanus/diphtheria 3-dose vaccination series with EHR-generated recommendations for immigrant and refugee patients at three U.S. health systems seen during 2017-2022. The EHR documented complete 3-dose tetanus/diphtheria vaccine series for 28 % of 50,829 adult immigrant and refugee patients by December 31, 2023. Among those without 3-dose documentation (n = 36,612), the EHR identified only 34 % as overdue for a tetanus/diphtheria vaccine. Clinicians are advised to recognize the risk of under-vaccination in immigrants and refugees and the importance of completing a 3-dose tetanus/diphtheria series despite absent EHR recommendations.