Tetanus Vaccination

Vaccination schedule

Tetanus is a global health problem. The disease occurs almost exclusively in persons who are non-immunised or inadequately immunised. In developing countries, most of the reported cases occur in infants and young children. Tetanus immunisation is administered by injecting tetanus toxoid, usually in conjunction with diphtheria and pertussis vaccines (DTP).

For primary vaccination, children should receive the toxoid at 2, 3, and 4 months of age. Booster doses are also given at 18 months, 6 years and 12 years. For primary immunisation of persons above 7 years of age, tetanus vaccine can be given together with a reduced concentration of diphtheria (Td). Usually, three doses of the formulation of tetanus-diphtheria toxoid are used. The first two doses are given 4 to 8 weeks apart and the third dose 6 to 12 months after the second. A Td booster should be used whenever 10 or more years have elapsed since completion of a primary series or the last booster dose.

Recommendations

Primary or booster doses are recommended for travellers to areas with risk. For those who frequently travel to such areas, a ten-yearly booster dose is recommended.

Adverse reactions

Mild reactions to DTP vaccination are fairly common such as slight fever, soreness or tenderness at the injection site but these are usually associated with the effect of the pertussis component. In less than 1% of the injections, DTP may cause the following complications: high fever (more than 40.5 degrees C.) or high-pitched cry. In about 1 out of 1750 immunisations, DTP can cause the following complications: febrile seizure in children, shock or even collapse. Brain damage is rarely reported after DTP injection.

Contraindications

If the child is sick with something more serious than a mild cold, DTP may be delayed until the child gets better. If the child has ever had a convulsion, other brain disorder, or even mal-development after birth, the DTP is often delayed until it is clear that the condition is not worsening or that seizures are under control. If a child has developed the following complications after an initial DTP vaccination, further immunisation may need to be delayed or avioded:

• seizures or any serious brain problem within 7 days after injection;
  
  
• allergy (mouth, throat or face swelling, or breathing difficulty);
  
  
• high fever ( more than 40.5 degree C.) within 2 days after injection;
  
  
• shock or collapse within 2 days after injection;
  
  
• persistent, uncontrolled crying that lasts for more than 3 hours at a time within 2 days after injection.