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Tetanus vaccine
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<h2 id="medical-uses">Medical uses</h2> <h3>Effectiveness</h3> <p>Vaccination confers near-complete protection from tetanus, provided the individual has received their recommended booster shots.<a class="footnote-ref" id="fnref:23" href="#fn:23"><sup>23</sup></a> Globally, deaths from tetanus in newborns decreased from 787,000 in 1988 to 58,000 in 2010, and 34,000 deaths in 2015 (a 96% decrease from 1988).<a class="footnote-ref" id="fnref:24" href="#fn:24"><sup>24</sup></a><a class="footnote-ref" id="fnref:25" href="#fn:25"><sup>25</sup></a> In the 1940s, before the vaccine, there were about 550 cases of tetanus per year in the United States, which has decreased to about 30 cases per year in the 2000s.<a class="footnote-ref" id="fnref:26" href="#fn:26"><sup>26</sup></a> Nearly all cases are among those who have never received a vaccine, or adults who have not stayed up to date on their 10-year booster shots.<a class="footnote-ref" id="fnref:27" href="#fn:27"><sup>27</sup></a> </p> <h3>Pregnancy</h3> <p>Guidelines on <a href="/facts/Prenatal_care_in_the_United_States/Iz3StMHw">prenatal care in the United States</a> specify that women should receive a dose of the <a href="/facts/Tdap_vaccine/oRGy9jGc">Tdap vaccine</a> during each pregnancy, preferably between weeks 27 and 36, to allow antibody transfer to the fetus.<a class="footnote-ref" id="fnref:28" href="#fn:28"><sup>28</sup></a><a class="footnote-ref" id="fnref:29" href="#fn:29"><sup>29</sup></a> All postpartum women who have not previously received the Tdap vaccine are recommended to get it prior to discharge after delivery.<a class="footnote-ref" id="fnref:30" href="#fn:30"><sup>30</sup></a> It is recommended for pregnant women who have never received the tetanus vaccine (i.e., neither DTP or DTaP, nor DT as a child or Td or TT as an adult) to receive a series of three Td vaccinations starting during pregnancy to ensure protection against maternal and <a href="/facts/Neonatal_tetanus/qKGVVkKg">neonatal tetanus</a>. In such cases, Tdap is recommended to be substituted for one dose of Td, again preferably between 27 and 36 weeks of gestation, and then the series completed with Td.<a class="footnote-ref" id="fnref:31" href="#fn:31"><sup>31</sup></a><a class="footnote-ref" id="fnref:32" href="#fn:32"><sup>32</sup></a> </p> <h3>Specific types</h3> <p>The first vaccine is given in infancy. The baby is injected with the <a href="/facts/DTaP/oRGy9jGc">DTaP</a> vaccine, which is three inactive toxins in one injection. DTaP protects against <a href="/facts/Diphtheria/IKFXNjAV">diphtheria</a>, <a href="/facts/Pertussis/LyrTdSeh">pertussis</a>, and tetanus. This acellular vaccine is safer than the previously used DTP with whole inactivated pertussis (now retroactively notated DTwP<a class="footnote-ref" id="fnref:33" href="#fn:33"><sup>33</sup></a>).<a class="footnote-ref" id="fnref:34" href="#fn:34"><sup>34</sup></a> Another option is DT, which is a combination of diphtheria and tetanus vaccines. This is given as an alternative to infants who have conflicts with the DTaP vaccine.<a class="footnote-ref" id="fnref:35" href="#fn:35"><sup>35</sup></a> Quadrivalent, pentavalent, and hexavalent formulations contain DTaP with one or more of the additional vaccines: inactivated <a href="/facts/Polio/6dYyXUhE">polio</a> virus vaccine (IPV), <a href="/facts/Haemophilus_influenzae_type_b/wqIpoDI1">Haemophilus influenzae type b</a> conjugate, <a href="/facts/Hepatitis_B/qqPTEY3p">Hepatitis B</a>, with the availability varying in different countries.<a class="footnote-ref" id="fnref:36" href="#fn:36"><sup>36</sup></a><a class="footnote-ref" id="fnref:37" href="#fn:37"><sup>37</sup></a><a class="footnote-ref" id="fnref:38" href="#fn:38"><sup>38</sup></a> </p><p>For the every ten-year booster Td or Tdap may be used, though Tdap is more expensive.<a class="footnote-ref" id="fnref:39" href="#fn:39"><sup>39</sup></a> </p> <h3>Schedule</h3> <p>Because DTaP and DT are administered to children less than a year old, the recommended location for injection is the anterolateral thigh muscle.[<i>medical citation needed</i>] However, these vaccines can be injected into the <a href="/facts/Deltoid_muscle/se9ub2Ld">deltoid muscle</a> if necessary.[<i>medical citation needed</i>] </p><p>The <a href="/facts/World_Health_Organization/YNN3bgug">World Health Organization</a> (WHO) recommends six doses in childhood starting at six weeks of age.<a class="footnote-ref" id="fnref:40" href="#fn:40"><sup>40</sup></a> Four doses of DTaP are to be given in early childhood.<a class="footnote-ref" id="fnref:41" href="#fn:41"><sup>41</sup></a> The first dose should be around two months of age, the second at four months, the third at six, and the fourth from fifteen to eighteen months of age. There is a recommended fifth dose to be administered to four- to six-year-olds.<a class="footnote-ref" id="fnref:42" href="#fn:42"><sup>42</sup></a> </p><p>Td and Tdap are for older children, adolescents, and adults and can be injected into the deltoid muscle.<a class="footnote-ref" id="fnref:43" href="#fn:43"><sup>43</sup></a> These are boosters and are recommended every ten years. It is safe to have shorter intervals between a single dose of Tdap and a dose of the Td booster.<a class="footnote-ref" id="fnref:44" href="#fn:44"><sup>44</sup></a> </p> <h4>Additional doses</h4> <p>Booster shots are important because <a href="/facts/Lymphocyte/pS2pv2Ma">lymphocyte</a> production (antibodies) is not at a constant high rate of activity. This is because after the introduction of the vaccine when lymphocyte production is high, the production activity of <a href="/facts/White_blood_cells/vsDunUK0">white blood cells</a> will start to decline. The decline in activity of the <a href="/facts/T-helper_cells/nhwAYkDj">T-helper cells</a> means that there must be a booster to help keep the white blood cells active.<a class="footnote-ref" id="fnref:45" href="#fn:45"><sup>45</sup></a> </p><p>Td and Tdap are the booster shots given every ten years to maintain immunity for adults nineteen years of age to sixty-five years of age.<a class="footnote-ref" id="fnref:46" href="#fn:46"><sup>46</sup></a> </p><p>Tdap is given as a one-time, first-time-only dose that includes the tetanus, diphtheria, and acellular pertussis vaccinations.<a class="footnote-ref" id="fnref:47" href="#fn:47"><sup>47</sup></a> This should not be administered to those who are under the age of eleven or over the age of sixty-five.[<i>medical citation needed</i>] </p><p>Td is the booster shot given to people over the age of seven and includes the tetanus and diphtheria <a href="/facts/Toxoid/qFAvxp7C">toxoids</a>. However, Td has less of the diphtheria toxoid, which is why the "d" is lowercase and the "T" is capitalized.<a class="footnote-ref" id="fnref:48" href="#fn:48"><sup>48</sup></a> </p><p>In 2020, the US <a href="/facts/Centers_for_Disease_Control_and_Prevention/NmoJNDV5">Centers for Disease Control and Prevention</a> (CDC) <a href="/facts/Advisory_Committee_on_Immunization_Practices/vNM2YzKH">Advisory Committee on Immunization Practices</a> (ACIP) recommended that either tetanus and diphtheria toxoids (Td) vaccine or Tdap to be used for the decennial Td booster, tetanus prevention during wound management, and for additional required doses in the catch-up immunization schedule if a person has received at least one Tdap dose.<a class="footnote-ref" id="fnref:49" href="#fn:49"><sup>49</sup></a> </p> <h2 id="side-effects">Side effects</h2> <p>Common side effects of the tetanus vaccine include fever, redness, and swelling with soreness or tenderness around the injection site (one in five people have redness or swelling). Body aches and tiredness have been reported following Tdap. Td / Tdap can cause painful swelling of the entire arm in one of 500 people.<a class="footnote-ref" id="fnref:50" href="#fn:50"><sup>50</sup></a><a class="footnote-ref" id="fnref:51" href="#fn:51"><sup>51</sup></a> Tetanus toxoid containing vaccines (DTaP, DTP, Tdap, Td, DT) may cause <a href="/facts/Brachial_neuritis/JNqsE9lj">brachial neuritis</a> at a rate of one out of every 100,000 to 200,000 doses.<a class="footnote-ref" id="fnref:52" href="#fn:52"><sup>52</sup></a><a class="footnote-ref" id="fnref:53" href="#fn:53"><sup>53</sup></a> </p> <h2 id="mechanism-of-action">Mechanism of action</h2> <p>The type of vaccination for this disease is called artificial <a href="/facts/Active_immunity/bc7zT1Jo">active immunity</a>. This type of <a href="/facts/Immunity_(medical)/vLPpzSNL">immunity</a> is generated when a dead or weakened version of the disease enters the body, causing an <a href="/facts/Immune_response/dtLulqIy">immune response</a> which includes the production of <a href="/facts/Antibodies/MX8pdTdP">antibodies</a>. This is beneficial because it means that if the disease is ever introduced into the body, the <a href="/facts/Immune_system/HRCTf1pb">immune system</a> will recognize the <a href="/facts/Antigen/9JlAernG">antigen</a> and produce antibodies more rapidly.<a class="footnote-ref" id="fnref:54" href="#fn:54"><sup>54</sup></a> </p> <h2 id="history">History</h2> <p>The first vaccine for passive immunology was discovered by a group of German scientists under the leadership of <a href="/facts/Emil_von_Behring/bk06nMKy">Emil von Behring</a> in 1890. The first inactive tetanus toxoid was discovered and produced in 1924. A more effective <a href="/facts/Adsorption/ARH9peYM">adsorbed</a> version of the vaccine, created in 1938, was proven to be successful when it was used to prevent tetanus in the military during <a href="/facts/World_War_II/2efV5L1U">World War II</a>.<a class="footnote-ref" id="fnref:55" href="#fn:55"><sup>55</sup></a> <a href="/facts/DPT_vaccine/oRGy9jGc">DTP/DTwP</a> (which is the combined vaccine for <a href="/facts/Diphtheria/IKFXNjAV">diphtheria</a>, tetanus, and <a href="/facts/Pertussis/LyrTdSeh">pertussis</a>) was first used in 1948, and was continued until 1991, when it was replaced with an acellular form of the pertussis vaccine due to safety concerns.<a class="footnote-ref" id="fnref:56" href="#fn:56"><sup>56</sup></a> Half of those who received the DT(w)P vaccine had redness, swelling, and pain around the injection site,<a class="footnote-ref" id="fnref:57" href="#fn:57"><sup>57</sup></a> which convinced researchers to find a replacement vaccine. </p><p>Two new vaccines were launched in 1992. These combined tetanus and diphtheria with acellular pertussis (TDaP or DTaP), which could be given to adolescents and adults (as opposed to previously when the vaccine was only given to children).<a class="footnote-ref" id="fnref:58" href="#fn:58"><sup>58</sup></a> </p> <h2 id="further-reading">Further reading</h2> <ul><li>Liang JL, Tiwari T, Moro P, Messonnier NE, Reingold A, Sawyer M, et al. (April 2018). <a href="https://www.cdc.gov/mmwr/volumes/67/rr/pdfs/rr6702a1-H.pdf">"Prevention of Pertussis, Tetanus, and Diphtheria with Vaccines in the United States: Recommendations of the Advisory Committee on Immunization Practices (ACIP)"</a> (PDF). <i>MMWR Recomm Rep</i>. 67 (2): 1–44. <a href="/facts/Doi_(identifier)/muM9Etpq">doi</a>:<a href="https://doi.org/10.15585%2Fmmwr.rr6702a1">10.15585/mmwr.rr6702a1</a>. <a href="/facts/ISSN_(identifier)/DPAflDvU">ISSN</a> <a href="https://search.worldcat.org/issn/1057-5987">1057-5987</a>. <a href="/facts/PMC_(identifier)/dX1zMt71">PMC</a> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5919600">5919600</a>. <a href="/facts/PMID_(identifier)/JlHAvMHt">PMID</a> <a href="https://pubmed.ncbi.nlm.nih.gov/29702631">29702631</a>.</li> <li>Kahn KE, Black CL, Ding H, Williams WW, Lu PJ, Fiebelkorn AP, et al. (September 2018). <a href="https://www.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6738a3-H.pdf">"Influenza and Tdap Vaccination Coverage Among Pregnant Women - United States, April 2018"</a> (PDF). <i>MMWR Morb. Mortal. Wkly. Rep</i>. 67 (38): 1055–1059. <a href="/facts/Doi_(identifier)/muM9Etpq">doi</a>:<a href="https://doi.org/10.15585%2Fmmwr.mm6738a3">10.15585/mmwr.mm6738a3</a>. <a href="/facts/PMC_(identifier)/dX1zMt71">PMC</a> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6188122">6188122</a>. <a href="/facts/PMID_(identifier)/JlHAvMHt">PMID</a> <a href="https://pubmed.ncbi.nlm.nih.gov/30260946">30260946</a>.</li> <li>World Health Organization (2018). <i>The immunological basis for immunization series: module 3: tetanus: update 2018</i>. <a href="/facts/World_Health_Organization/YNN3bgug">World Health Organization</a> (WHO). <a href="/facts/Hdl_(identifier)/rdebSxmC">hdl</a>:<a href="https://hdl.handle.net/10665%2F275340">10665/275340</a>. <a href="/facts/ISBN_(identifier)/15AdSPa9">ISBN</a> 9789241513616. License: CC BY-NC-SA 3.0 IGO.</li> <li>Ramsay M, ed. (21 January 2021). <a href="https://www.gov.uk/government/publications/tetanus-the-green-book-chapter-30">"Chapter 30: Tetanus"</a>. <a href="https://www.gov.uk/government/collections/immunisation-against-infectious-disease-the-green-book"><i>Immunisation against infectious disease</i></a>. Public Health England.</li> <li>Hall E, Wodi AP, Hamborsky J, Morelli V, Schillie S, eds. (2021). <a href="https://www.cdc.gov/vaccines/pubs/pinkbook/tetanus.html">"Chapter 21: Tetanus"</a>. <a href="https://www.cdc.gov/vaccines/pubs/pinkbook/index.html"><i>Epidemiology and Prevention of Vaccine-Preventable Diseases</i></a> (14th ed.). Washington D.C.: U.S. <a href="/facts/Centers_for_Disease_Control_and_Prevention/NmoJNDV5">Centers for Disease Control and Prevention</a> (CDC).</li> <li>Roush SW, Baldy LM, Hall MA, eds. (March 2019). <a href="https://www.cdc.gov/vaccines/pubs/surv-manual/chpt16-tetanus.html">"Chapter 16: Tetanus"</a>. <a href="https://www.cdc.gov/vaccines/pubs/surv-manual/"><i>Manual for the surveillance of vaccine-preventable diseases</i></a>. Atlanta GA: U.S. <a href="/facts/Centers_for_Disease_Control_and_Prevention/NmoJNDV5">Centers for Disease Control and Prevention</a> (CDC).</li></ul> <h2 id="external-links">External links</h2> Wikimedia Commons has media related to Tetanus vaccination. <ul><li><a href="https://www.cdc.gov/vaccines/hcp/vis/vis-statements/td.html">"Td (Tetanus, Diphtheria) Vaccine Information Statement"</a>. <i>U.S. <a href="/facts/Centers_for_Disease_Control_and_Prevention/NmoJNDV5">Centers for Disease Control and Prevention</a> (CDC)</i>. August 2021.</li> <li><a href="https://www.cdc.gov/vaccines/hcp/vis/vis-statements/dtap.html">"DTaP (Diphtheria, Tetanus, Pertussis) Vaccine Information Statement"</a>. <i>U.S. <a href="/facts/Centers_for_Disease_Control_and_Prevention/NmoJNDV5">Centers for Disease Control and Prevention</a> (CDC)</i>. August 2021.</li> <li><a href="https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/dtap.html">"DTaP/Tdap/Td ACIP Vaccine Recommendations"</a>. <i><a href="/facts/Centers_for_Disease_Control_and_Prevention/NmoJNDV5">Centers for Disease Control and Prevention</a> (CDC)</i>. 28 January 2020.</li> <li><a href="https://meshb.nlm.nih.gov/record/ui?name=Tetanus+Toxoid">Tetanus Toxoid</a> at the U.S. National Library of Medicine <a href="/facts/Medical_Subject_Headings/C57g2JuF">Medical Subject Headings</a> (MeSH)</li> <li><a href="https://meshb.nlm.nih.gov/record/ui?name=Diphtheria-Tetanus+Vaccine">Diphtheria-Tetanus Vaccine</a> at the U.S. National Library of Medicine <a href="/facts/Medical_Subject_Headings/C57g2JuF">Medical Subject Headings</a> (MeSH)</li> <li><a href="https://meshb.nlm.nih.gov/record/ui?name=Diphtheria-Tetanus-Pertussis+Vaccine">Diphtheria-Tetanus-Pertussis Vaccine</a> at the U.S. National Library of Medicine <a href="/facts/Medical_Subject_Headings/C57g2JuF">Medical Subject Headings</a> (MeSH)</li> <li><a href="https://meshb.nlm.nih.gov/record/ui?name=Diphtheria-Tetanus-acellular+Pertussis+Vaccines">Diphtheria-Tetanus-acellular Pertussis Vaccines</a> at the U.S. National Library of Medicine <a href="/facts/Medical_Subject_Headings/C57g2JuF">Medical Subject Headings</a> (MeSH)</li></ul> <h2 id="references">References</h2> <ol> <li id="fn:1"><p>World Health Organization (February 2017). "Tetanus vaccines: WHO position paper – February 2017" (PDF). Weekly Epidemiological Record. 92 (6): 53–76. hdl:10665/254583. PMID 28185446. <a href="/wiki/World_Health_Organization" target="_blank">/wiki/World_Health_Organization</a> <a href="#fnref:1" class="footnote-back-ref">↩</a></p></li> <li id="fn:2"><p>World Health Organization (February 2017). "Tetanus vaccines: WHO position paper – February 2017" (PDF). Weekly Epidemiological Record. 92 (6): 53–76. hdl:10665/254583. PMID 28185446. <a href="/wiki/World_Health_Organization" target="_blank">/wiki/World_Health_Organization</a> <a href="#fnref:2" class="footnote-back-ref">↩</a></p></li> <li id="fn:3"><p>World Health Organization (February 2017). "Tetanus vaccines: WHO position paper – February 2017" (PDF). Weekly Epidemiological Record. 92 (6): 53–76. hdl:10665/254583. PMID 28185446. <a href="/wiki/World_Health_Organization" target="_blank">/wiki/World_Health_Organization</a> <a href="#fnref:3" class="footnote-back-ref">↩</a></p></li> <li id="fn:4"><p>Hamborsky J, Kroger A, Wolfe S, eds. (2015). "Chapter 21: Tetanus". Epidemiology and Prevention of Vaccine-Preventable Diseases (13th ed.). Centers for Disease Control and Prevention (CDC). Archived from the original on 13 April 2017. This article incorporates text from this source, which is in the public domain. <a href="https://www.cdc.gov/vaccines/pubs/pinkbook/tetanus.html" target="_blank">https://www.cdc.gov/vaccines/pubs/pinkbook/tetanus.html</a> <a href="#fnref:4" class="footnote-back-ref">↩</a></p></li> <li id="fn:5"><p>"Puncture wounds: First aid". Mayo Clinic. 4 February 2015. Archived from the original on 8 December 2015. Retrieved 6 December 2015. <a href="http://www.mayoclinic.org/first-aid/first-aid-puncture-wounds/basics/art-20056665" target="_blank">http://www.mayoclinic.org/first-aid/first-aid-puncture-wounds/basics/art-20056665</a> <a href="#fnref:5" class="footnote-back-ref">↩</a></p></li> <li id="fn:6"><p>World Health Organization (February 2017). "Tetanus vaccines: WHO position paper – February 2017" (PDF). Weekly Epidemiological Record. 92 (6): 53–76. hdl:10665/254583. PMID 28185446. <a href="/wiki/World_Health_Organization" target="_blank">/wiki/World_Health_Organization</a> <a href="#fnref:6" class="footnote-back-ref">↩</a></p></li> <li id="fn:7"><p>Centers for Disease Control Prevention (CDC) (February 2013). "Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) in pregnant women--Advisory Committee on Immunization Practices (ACIP), 2012" (PDF). MMWR Morb. Mortal. Wkly. Rep. 62 (7): 131–5. PMC 4604886. PMID 23425962. This article incorporates text from this source, which is in the public domain. <a href="https://www.cdc.gov/mmwr/pdf/wk/mm6207.pdf" target="_blank">https://www.cdc.gov/mmwr/pdf/wk/mm6207.pdf</a> <a href="#fnref:7" class="footnote-back-ref">↩</a></p></li> <li id="fn:8"><p>Havers FP, Moro PL, Hunter P, Hariri S, Bernstein H (January 2020). "Use of Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis Vaccines: Updated Recommendations of the Advisory Committee on Immunization Practices - United States, 2019" (PDF). MMWR Morb. Mortal. Wkly. Rep. 69 (3): 77–83. doi:10.15585/mmwr.mm6903a5. PMC 7367039. PMID 31971933. This article incorporates text from this source, which is in the public domain. <a href="https://www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6903a5-H.pdf" target="_blank">https://www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6903a5-H.pdf</a> <a href="#fnref:8" class="footnote-back-ref">↩</a></p></li> <li id="fn:9"><p>World Health Organization (February 2017). 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