A vaccine for tetanus Tetanus Tetanus is acute poisoning resulting from a neurotoxin produced by Clostridium tetani. Symptoms are intermittent tonic spasms of voluntary muscles. Spasm of the masseters accounts for... read more 
alone is available, but the tetanus vaccine is typically combined with those for diphtheria Diphtheria Diphtheria is an acute pharyngeal or cutaneous infection caused mainly by toxigenic strains of the gram-positive bacillus Corynebacterium diphtheriae and rarely by other, less common... read more 
and/or pertussis Pertussis Pertussis is a highly communicable disease occurring mostly in children and adolescents and caused by the gram-negative bacterium Bordetella pertussis. Symptoms are initially those of... read more . 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 Overview of Immunization Immunity can be achieved Actively by using antigens (eg, vaccines, toxoids) Passively by using antibodies (eg, immune globulins, antitoxins) A toxoid is a bacterial toxin that has been modified... read more .)
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 Diphtheria-Tetanus-Pertussis Vaccine Vaccines that contain diphtheria toxoid, tetanus toxoid, and acellular pertussis help protect against diphtheria, tetanus, and pertussis, but they do not prevent all cases. For more information... read more ) 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 ) 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 Anaphylaxis Anaphylaxis is an acute, potentially life-threatening, IgE-mediated allergic reaction that occurs in previously sensitized people when they are reexposed to the sensitizing antigen. Symptoms... read more ) after a previous dose or to a vaccine component
Precautions with Td include
Guillain-Barré syndrome Guillain-Barré Syndrome (GBS) Guillain-Barré syndrome is an acute, usually rapidly progressive but self-limited inflammatory polyneuropathy characterized by muscular weakness and mild distal sensory loss. Cause is thought... read more 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 Type III Allergic (including atopic) and other hypersensitivity disorders are inappropriate or exaggerated immune reactions to foreign antigens. Inappropriate immune reactions include those that are... read more 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
