The primary series of 3 doses of a tetanus toxoid containing vaccine should be given in infancy (age <1year) with a first dose of booster at 18 months of age followed by the second booster before school entry so that the school going child is completely immunised against tetanus. However, the WHO suggests that in addition to the childhood vaccination programme, an extra tetanus toxoid or tetanus toxoid containing vaccine dose to adults, as it has been found that immunity after 5 doses wanes in adult life. This will provide additional assurance of long lasting, possibly lifelong protection against tetanus. Therefore a sixth dose is recommended for adolescents at age 10-15 years as aTd or dTpa and for young adults as TT. which can be routinely and conveniently given eg. at the time of, the first pregnancy, induction to military service, the medical examination before first employment, admission to universities and higher centres of training, wound management. Those who receive their first tetanus vaccine doses as adolescents or adults require a total of 5 appropriately spaced doses to obtain the same long-term protection. Dosage and administration – for infants and children See Chapter 3 Dosage and administration – for adolescents and adults
Administration – Deep intramuscularly into deltoid or antero-lateral aspect of thigh. Subcutaneous injection can cause local irritation, inflammation, granuloma formation and necrosis Tetanus toxoid in pregnancy – (Please refer Annexure 1 National Immunisation Schedule). Pregnant women with an inadequate or unknown immunisation history should always receive 2 doses of tetanus vaccine: the first dose administered after completion of 12 weeks of pregnancy and the second dose at least 4 weeks later. The second dose should be given at least 2 weeks prior to delivery. Effort should be made to complete the recommended series of 5 immunisations while respecting the minimum intervals between doses. Contraindications Hypersensitivity to any component of the vaccine. Adverse effects Anaphylactic reactions, Guillain-Barre syndrome, and brachial neuritis attributable to tetanus toxoid have been reported but are rare.
Dosage - 0.5 mL of tetanus toxoid
Storage
3 injections as follows – 1 stat, 2nd 6 weeks later, 3rd 6 months later.
2ºC-8ºC. Do not freeze.
A history regarding tetanus immunisation should always be taken before tetanus toxoid is given for wound prophylaxis. Tetanus toxoid need not be given to children with a history of complete immunisation with 5 doses of tetanus toxoid. Adults with a history of immunisation with only 5 doses of tetanus toxoid in childhood need 1 dose. Adults with a history of immunisation with 6 doses of tetanus toxoid including the 5 received in childhood do not need tetanus toxoid for wound prophylaxis. Persons who have had initial tetanus immunisation in adolescence or adulthood with 5 doses of toxoid do not need any doses for prophylaxis. One dose given to a person not immunised against tetanus will not produce effective immunity 99
Further reading 1. The Merck Manual 2006; Beers MH. Ed in Chief. 18th ed. Merck & Co Inc, Rahway, New Jersey, USA. 120-3. 2. American Academy of Pediatrics. Active Immunisation. In: Pickering LK et al, eds. Red Book: 2009 Report of the Committee on Infectious Diseases. 28th ed. Elk Grove Village, IL. American Academy of Pediatrics; 2009: 9-55. 3. http://www.who.int/immunization/wer8120tetanus_May06_ position_paper.pdf 100