A vaccine for tetanus alone is available, but the tetanus vaccine is typically combined with those for diphtheria and/or pertussis. The vaccine for diphtheria is available only in combination with other vaccines.
For more information, see DTaP/Tdap/Td Advisory Committee on Immunization Practices Vaccine Recommendations and Centers for Disease Control and Prevention (CDC): Diphtheria, Tetanus, and Pertussis Vaccination.
(See also Overview of Immunization.)
Preparations of Tetanus-Diphtheria Vaccine
The most widely used preparations combine tetanus toxoid with diphtheria toxoid (Td for adults; DT, which contains a higher dose of diphtheria toxoid, for children); a preparation with only tetanus toxoid (TT) is also available but is not recommended because periodic boosting is needed for both antigens. Tetanus-diphtheria-pertussis (Tdap) is an adolescent and adult preparation that contains a pertussis component.
Indications for Tetanus-Diphtheria Vaccine
Tetanus-diphtheria (Td) or Tdap boosters are given routinely every 10 years after the Tdap booster is given at age 11 to 12 years. Patients who have not received or completed a primary vaccination series of at least 3 doses of tetanus and diphtheria vaccine should begin or complete the series. (See Centers for Disease Control and Prevention (CDC) Child and Adolescent Immunization Schedule by Age and Adult Immunization Schedule by Age.)
Patients who have a wound that poses an increased risk of tetanus (see table Tetanus Prophylaxis in Routine Wound Management) should be given a Td or Tdap booster if ≥ 5 years have elapsed since the previous dose. One dose of Tdap should be substituted for a Td booster if adults have never received Tdap.
Pregnant women should receive 1 dose of Tdap during each pregnancy, irrespective of their history of receiving the vaccine. Tdap should be administered at 27 to 36 weeks gestation, preferably during the earlier part of this period, although it may be administered at any time during pregnancy.
Contraindications and Precautions for Tetanus-Diphtheria Vaccine
The main contraindication for Td is
A severe allergic reaction (eg, anaphylaxis) after a previous dose or to a vaccine component
Precautions with Td include
Guillain-Barré syndrome within 6 weeks after a previous dose of a vaccine that contains tetanus toxoid
Moderate or severe acute illness with or without fever
History of type III hypersensitivity reactions after a previous dose of a vaccine that contains tetanus or diphtheria toxoid (vaccination is postponed until ≥ 10 years since the last dose of a vaccine that contains tetanus toxoid)
Dose and Administration of Tetanus-Diphtheria Vaccine
The Td dose is 0.5 mL IM. Booster vaccinations are given every 10 years.
Adverse Effects of Tetanus-Diphtheria Vaccine
Adverse effects are very rare. They include anaphylactic reactions and brachial neuritis. Mild effects include erythema, swelling, and soreness at the injection site.
More Information
The following English-language resources may be useful. Please note that THE MANUAL is not responsible for the content of these resources.
Advisory Committee on Immunization Practices (ACIP): DTaP/Tdap/Td ACIP Vaccine Recommendations
Centers for Disease Control and Prevention (CDC): Diphtheria, Tetanus, and Pertussis Vaccination: Information for Healthcare Professionals
European Centre for Disease Prevention and Control (ECDC): Diphtheria: Recommended vaccinations
European Centre for Disease Prevention and Control (ECDC): Tetanus: Recommended vaccinations
