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 Tdap/Td Advisory Committee on Immunization Practices Vaccine Recommendations.
(See also Overview of Immunization.)
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.
Tetanus-diphtheria (Td) 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.
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 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.
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)