Tetanus vaccine, also known as tetanus toxoid (TT), is a toxoid vaccine used to prevent tetanus. During childhood, five doses are recommended, with a sixth given during adolescence.
After three doses, almost everyone is initially immune, but additional doses every ten years are recommended to maintain immunity. A booster shot should be given within 48 hours of an injury to people whose immunization is out of date.
Confirming that pregnant women are up to date on tetanus immunization during each pregnancy can prevent both maternal and neonatal tetanus.
The vaccine is very safe, including during pregnancy and in those with HIV/AIDS.
Redness and pain at the site of injection occur in between 25% and 85% of people. Fever, feeling tired, and minor muscle pain occurs in less than 10% of people. Severe allergic reactions occur in less than one in 100,000 people.
A number of vaccine combinations include the tetanus vaccine, such as DTaP and Tdap, which contain diphtheria, tetanus, and pertussis vaccines, and DT and Td, which contain diphtheria and tetanus vaccines. DTaP and DT are given to children less than seven years old, while Tdap and Td are given to those seven years old and older. The lowercase d and p denote lower strengths of diphtheria and pertussis vaccines.
Tetanus antiserum was developed in 1890, with its protective effects lasting a few weeks. The tetanus toxoid vaccine was developed in 1924, and came into common use for soldiers in World War II. Its use resulted in a 95% decrease in the rate of tetanus. It is on the World Health Organization's List of Essential Medicines.
Medical uses
Effectiveness
Following vaccination, 95% of people are protected from diphtheria, 80% to 85% from pertussis, and 100% from tetanus. Globally deaths from tetanus in newborns decreased from 787,000 in 1988 to 58,000 in 2010, and 34,000 deaths in 2015 (a 96% decrease from 1988).
In the 1940s, before the vaccine, there were about 550 cases of tetanus per year in the United States, which has decreased to about 30 cases per year in the 2000s. Nearly all cases are among those who have never received a vaccine, or adults who have not stayed up to date on their 10-year booster shots.
Pregnancy
Guidelines on prenatal care in the United States specify that women should receive a dose of the Tdap vaccine during each pregnancy, preferably between weeks 27 and 36, to allow antibody transfer to the fetus. All postpartum women who have not previously received the Tdap vaccine are recommended to get it prior to discharge after delivery. It is recommended for pregnant women who have never received the tetanus vaccine (i.e., neither DTP or DTaP, nor DT as a child or Td or TT as an adult) to receive a series of three Td vaccinations starting during pregnancy to ensure protection against maternal and neonatal tetanus. In such cases, Tdap is recommended to be substituted for one dose of Td, again preferably between 27 and 36 weeks of gestation, and then the series completed with Td.
Specific types
The first vaccine is given in infancy. The baby is injected with the DTaP vaccine, which is three inactive toxins in one injection. DTaP protects against diphtheria, pertussis, and tetanus. This acellular vaccine is safer than the previously used DTP with whole inactivated pertussis (now retroactively notated DTwP). Another option is DT, which is a combination of diphtheria and tetanus vaccines. This is given as an alternative to infants who have conflicts with the DTaP vaccine. Quadrivalent, pentavalent, and hexavalent formulations contain DTaP with one or more of the additional vaccines: inactivated polio virus vaccine (IPV), Haemophilus influenzae type b conjugate, Hepatitis B, with the availability varying in different countries.
For the every ten-year booster Td or Tdap may be used, though Tdap is more expensive.
Schedule
Because DTaP and DT are administered to children less than a year old, the recommended location for injection is the anterolateral thigh muscle. However, these vaccines can be injected into the deltoid muscle if necessary.
The World Health Organization (WHO) recommends six doses in childhood starting at six weeks of age. Four doses of DTaP are to be given in early childhood. The first dose should be around two months of age, the second at four months, the third at six, and the fourth from fifteen to eighteen months of age. There is a recommended fifth dose to be administered to four- to six-year-olds.