Tetanus Vaccine Overview

Tetanus is a bacterial infection that attacks the nervous system. Tetanus may result in severe muscle spasms, and this can lead to a condition known as lockjaw, which prevents the mouth from opening and closing. Tetanus can be fatal.

Tetanus is caused when the bacterium, Clostridium tetani, enters the body through a break in the skin. The bacterium can come from soil, dust, or manure. It produces a toxin that causes the illness.

This infection is most common in people aged 50 years and older. Also, people who have not been immunized for tetanus, who do not update their tetanus shot regularly, who use intravenous (IV) drugs, who have skin sores or wounds, or who have had burns or open wounds exposed to soil or animal feces are at increased risk of developing tetanus.

In the United States and other countries with tetanus vaccination programs, the condition is rare. In fact, there have been fewer than 50 cases of tetanus reported each year in the United States since 1995.

Symptoms include:

• Headache
• Stiff jaw or neck muscles
• Drooling or trouble swallowing
• Muscle spasticity or rigidity
• Sweating
• Fever
• Irritability
• Pain or tingling at the wound site
• High or low blood pressure
• Seizures
• Difficulty breathing
• Irregular heartbeat
• Cardiac arrest
• Dehydration
• Pneumonia

Symptoms usually begin seven days after the bacteria enter the body, but can begin anywhere from three days to three weeks after infection occurs.

Treatment for tetanus may include:

• Hospitalization to manage complications of the infection
• Opening and cleaning of the wound
• Surgical removal of the entire wound
• Antibiotics
• Tetanus immune globulin (antibodies against tetanus that help neutralize the tetanus toxin)
• A tetanus shot, if tetanus vaccines are not up-to-date
• A breathing tube or tracheotomy in cases of troubled breathing or swallowing

The tetanus vaccine is an inactivated toxoid (a substance that can create an antitoxin). It is made by growing the tetanus bacteria and purifying and inactivating the toxin it produces. Although the tetanus vaccine is available as a single vaccine; it is most commonly given in combination with diphtheria vaccine (referred to as DT and Td). Other combinations, referred to as DTaP and Tdap, contain tetanus, diphtheria, and pertussis vaccines . These vaccines, which must be stored in a refrigerator before given, are injected into the muscle, usually in the arm or thigh.

The DTaP vaccine is generally required before starting school. The regular immunization schedule (for children and adults) is as follows:

• DTaP vaccines at 2, 4, and 6 months, 15-18 months, and 4-6 years of age
• Booster dose of Tdap given at 11 or 12 years old for children who have not already had the Td booster—Those aged 13-18 years who missed the above booster dose or received Td only can get one dose of Tdap five years after the last dose.
• Booster of Tdap (one time dose for ages 19-64 years) or Td (every 10 years) to provide continued protection

For children aged 4 months to 6 years who have not yet received the vaccination, the Centers for Disease Control and Prevention (CDC) recommend the following catch-up schedule:

Doses

Minimum Interval Between Doses

First and second dose

4 weeks

Second and third dose

4 weeks

Third and fourth dose

6 months

Fourth and fifth dose

6 months

• The fifth dose is not necessary if the fourth dose was administered at age 4 years or older.
• DTaP is not indicated for persons aged 7 years or older.

Children seven years and older and adults who have not been vaccinated should also be vaccinated. The choice and timing of vaccination varies depending on age and prior vaccine exposure.

People who meet the following criteria should also get the vaccine:

• Adults who expect to have close contact with an infant younger than 12 months should get a dose of Tdap (with a waiting time of two years since the last dose of Td)
• Healthcare workers who have direct patient contact within hospitals or clinics should get a dose of Tdap (with a waiting time of two years since the last dose of Td)
• Pregnant women:

• If the last dose of Td was 10 years ago or longer, they should get a dose of Td.
• If the last dose of Td was less than 10 years ago, they should get a dose of Tdap after giving birth.

The vaccines are also given if someone has a severe cut or burn.

Most people tolerate the tetanus-containing vaccines without any trouble. The most common side effects are pain, redness, or swelling at the injection site, mild fever, headache, tiredness, nausea, vomiting, diarrhea , or stomachache.

Rarely, a fever of more than 102ºF, severe gastrointestinal problems, or severe headache may occur. Nervous system problems and severe allergic reactions are extremely rare. Localized allergic reactions (redness and swelling) at the injection site may occur, while anaphylaxis (life-threatening, widespread allergic reaction) is extremely rare.

Acetaminophen (eg, Tylenol) is sometimes given to reduce pain and fever that may occur after getting a vaccine. In infants, the medicine may weaken the vaccine's effectiveness. Discuss the risks and benefits of taking acetaminophen with the doctor.

The vast majority of people should receive their tetanus-containing vaccinations on schedule. However, individuals in whom the risks of vaccination outweigh the benefits include those who:

• Have had a life-threatening allergic reaction to DTP, DTap, DT, Tdap, or Td vaccine
• Have had a severe allergy to any component of the vaccine to be given
• Have gone into a coma or long seizure within seven days after a dose of DTP or DTaP

Talk with your doctor before getting the vaccine if you have:

• Allergy to latex
• Epilepsy or other nervous system problem
• Severe swelling or severe pain after a previous dose of any component of the vaccination to be given
• Guillain-Barre syndrome

Wait until you recover to get the vaccine if you have moderate or severe illness on the day your shot is scheduled.

Caring properly for wounds, including promptly cleaning them and seeing a doctor for medical care, can prevent a tetanus infection.

WHERE CAN I GET MORE INFORMATION?

Immunization Initiatives
American Academy of Pediatrics
http://www.cispimmunize.org/

National Immunization Program
Centers for Disease Control and Prevention
http://www.cdc.gov/vaccines/

References:

Advisory Committee on Immunization Practices. Recommended adult immunization schedule: United States, 2009. Ann Intern Med. 2009;150:40-44.

CDC National Immunization Program website. Available at: http://www.cdc.gov/nip/ . Accessed February 5, 2007.

Immunization Action Coalition website. Available at: http://www.immunize.org/ . Accessed February 5, 2007.

National Foundation for Infectious Diseases website. Available at: http://www.nfid.org/ . Accessed February 5, 2007.

Nemours Foundation website. Available at: http://www.nemours.org/index.html . Accessed February 5, 2007.

1/31/2008 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Centers for Disease Control and Prevention. Recommended immunization schedules for persons aged 0-18 years—United States, 2008. MMWR. 2008;57;Q1-Q4. Centers for Disease Control and Prevention, MMWR website. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5701a8.htm . Updated January 10, 2008. Accessed January 28, 2008.

10/30/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Prymula R, Siegrist C, Chlibek R, et al. Effect of prophylactic paracetamol administration at time of vaccination on febrile reactions and antibody responses in children: two open-label, randomised controlled trials. Lancet. 2009;374(9698):1339.