Tetanus Vaccine
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Tetanus Vaccine

(Lockjaw Vaccine)

En Español (Spanish Version)

What Is Tetanus?

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 that comes from soil, dust, or manure, enters the body through a break in the skin. The bacterium 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

What Is the Tetanus Vaccine?

The tetanus vaccine in 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.

Who Should Get Vaccinated and When?

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, 6 months, 15-18 months, and 4-6 years of age
  • Booster dose of Tdap given at 11 or 12 years old—This is 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 receive one dose of Tdap 5 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:

DosesMinimum Interval Between Doses
First and second dose4 weeks
Second and third dose4 weeks
Third and fourth dose6 months
Fourth and fifth dose6 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 will vary based on age and prior vaccine exposure.*

It is recommended that adults who expect to have close contact with an infant younger than 12 months get a dose of Tdap, with an encouraged, but not required, waiting time of two years since the last dose of Td. Also, healthcare workers who have direct patient contact with hospitals or clinics should get a dose of Tdap, with a recommended two-year waiting period since the last dose of Td. Finally, new mothers who have never received a dose of Tdap should get a dose as soon as possible after delivery, as long as two years or more have elapsed from a previous TD administration.

For an adolescent or adult who gets a severe cut or burn, a dose of Tdap or Td is recommended to protect against tetanus infection. Td is recommended in place of Tdap if: Tdap is not available, for anyone who has already had a dose of Tdap, adults aged 65 and older, and children aged 7-9 years old. Also, Td is usually preferred over Tdap for pregnant women.

What Are the Risks Associated With the Tetanus Vaccine?

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.

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

Who Should Not Get Vaccinated?

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.

What Other Ways Can Tetanus Be Prevented Besides Vaccination?

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:

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.

*Updated Who Should Get Vaccinated and When section on 1/31/2008 according to the following study, as cited by 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.



Last reviewed February 2008 by David Horn, MD, FACP

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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