What is the tetanus vaccine and what does it do?
There are four kinds of tetanus vaccines that are used to protect you from tetanus and are combined with vaccines for other diseases associated with tetanus:
- Diphtheria and tetanus (DT) vaccines
- Diphtheria, tetanus, and pertussis (also known as whooping cough) vaccines (DTaP)
- Tetanus and diphtheria (Td) vaccines
- Tetanus, diphtheria, and pertussis (also known as whooping cough) vaccines (Tdap)
How many doses will I need?
The DTaP and DT preparations are all given as an injection in the anterolateral thigh muscle (for infants and young toddlers) or the deltoid muscle (for older children and adults). Tdap and Td are given in the deltoid muscle for children and adults (age seven and older). The usual schedule for infants is a series of four doses of DTaP given at the ages of two, four, six, and 15–18 months of age. A fifth shot, or booster dose, is recommended between age four and six years of age unless the fourth dose was given late (after the fourth birthday).
If you have never been vaccinated or haven’t completed the series of shots, a three-dose series of Td should be given within one to two months between the first and second dose, and six to 12 months between the second and third.
Adolescents and adults who have recently received the Td vaccine can be given Tdap without any waiting period. If you are younger than 65 years of age, one of the doses — preferably the first — should also contain the pertussis component in the form of Tdap. If you are 65 or older, you may also get the Tdap vaccine.
Because immunity to diphtheria and tetanus wanes with time, boosters of Td are needed every ten years. Older children and adults who haven’t received a pertussis-containing vaccine between the ages of ten and 64 should substitute a one-time dose of Tdap (with acellular pertussis) for one of the booster doses of Td.
It is essential to keep an up-to-date record of all immunizations, so that repeat doses do not become necessary. Although it is vital to be adequately protected, receiving more doses than recommended can lead to increased local reactions, such as painful swelling of the arm.
When adolescents and adults are scheduled for their routine tetanus and diphtheria booster, should they get vaccinated with Td or Tdap?
ID Care immunization experts recommend that the first dose of Tdap be given to all adolescents at the age of 11 or 12 as a booster during their routine adolescent immunization visit — if the adolescent has finished the childhood DTaP schedule and has not already received a dose of Td or Tdap. If a seven or 10-year-old child did not complete a primary series in childhood, a one-time dose of Tdap might be given earlier as part of the catch-up vaccinations.
Who are the vaccines recommended for?
- All people who need protection against diphtheria, tetanus, and pertussis — especially when traveling abroad
- Older children and adults without documentation of ever receiving the basic series of shots should receive a primary series of three doses, properly spaced
- A single dose of Tdap is recommended for people age 11-64 in place of one of the Td doses, preferably the next one needed
- Adults that are 65 years of age or older and anticipate having close contact with an infant younger than age 12 months (e.g., grandparents, childcare providers, healthcare providers)
- Children, seven through ten years of age, who have not completed a full primary series of DTaP
- Unvaccinated older adults (65 years or older) who do not anticipate having contact with an infant but want to be vaccinated with Tdap could be given a one-time dose
- All adults younger than the age of 65 should receive a one-time dose to Tdap as soon as possible (with subsequent booster doses given every ten years)
- If an individual experiences a deep puncture wound or a wound that’s been contaminated by dirt, an additional booster shot should be provided if the last dose was given more than five years ago (depending on the person’s vaccination history, this can be a dose of either Td or Tdap)
Who should not receive these vaccines?
- Any person who has had a severe allergic reaction to a vaccine component should not receive another dose of the same vaccine
- People who have had a severe allergic reaction to a previous dose of DTaP or Tdap
- Any person with a recognized, possible, or potential neurological condition should delay receiving the DTaP or Tdap vaccines until they are evaluated, treated, and/or stabilized — although the DTaP vaccine does not cause any neurological disorders, receiving it can cause an already-present underlying condition to activate
How effective are these vaccines?
After a properly spaced primary series of DTaP or Td/Tdap, approximately 95% of people will have protective levels of diphtheria antitoxin and 100% will have protective levels of tetanus antitoxin in their blood. However, antitoxin levels decrease with time, so routine boosters with tetanus and diphtheria toxoids are recommended every ten years. The acellular pertussis vaccine efficacy ranges from approximately 80% to 85%, which is believed to be far more efficacious than the previously used whole-cell pertussis vaccine.
Are there any potential side effects or risks associated with these vaccines?
It’s not uncommon for children and adults to experience fever, redness, tenderness, swelling, and soreness at the injection site. These minor and adverse reactions are much less common with the acellular DTaP vaccine. However, a determination of other, rarer adverse effects can only be made when additional data are available following extended use of DTaP.
Side effects following the Td or Tdap vaccine in older children and adults include redness and swelling at the injection site (following the Td vaccine), as well as generalized body aches and tiredness (following the Tdap vaccine). Older children and adults who received more than the recommended doses of Td or Tdap vaccine may experience increased local reactions, such as painful swelling of the arm — this is due to the high levels of tetanus antibody in their blood.