Tetanus vaccine

Tetanus vaccine

Tetanus vaccination is often administered via combination DPT vaccines
Vaccine description
Target	Tetanus
Vaccine type	Toxoid
Clinical data
MedlinePlus	a682198
License data	US DailyMed: Tetanus
Routes of administration	Injection
ATC code	J07AM01 (WHO)
Legal status
Legal status	US: ℞-only EU: Rx-only[1]
Identifiers
CAS Number	93384-51-1
ChemSpider	none
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Tetanus vaccine, also known as tetanus toxoid (TT), is a toxoid vaccine used to prevent tetanus.^[2] During childhood, five doses are recommended, with a sixth given during adolescence.^[2]

After three doses, almost everyone is initially immune,^[2] but additional doses every ten years are recommended to maintain immunity.^[3] A booster shot should be given within 48 hours of an injury to people whose immunization is out of date.^[4]

Confirming that pregnant women are up to date on tetanus immunization during each pregnancy can prevent both maternal and neonatal tetanus.^[2][5][6] The vaccine is very safe, including during pregnancy and in those with HIV/AIDS.^[2]

Redness and pain at the site of injection occur in between 25% and 85% of people.^[2] Fever, feeling tired, and minor muscle pain occurs in less than 10% of people.^[2] Severe allergic reactions occur in fewer than one in 100,000 people.^[2]

A number of vaccine combinations include the tetanus vaccine, such as DTaP and Tdap, which contain diphtheria, tetanus, and pertussis vaccines, and DT and Td, which contain diphtheria and tetanus vaccines.^[7] DTaP and DT are given to children less than seven years old, while Tdap and Td are given to those seven years old and older.^[7][8] The lowercase d and p denote lower strengths of diphtheria and pertussis vaccines.^[7]

Tetanus antiserum was developed in 1890, with its protective effects lasting a few weeks.^[9][10] The tetanus toxoid vaccine was developed in 1924, and came into common use for soldiers in World War II.^[2][11] Its use resulted in a 95% decrease in the rate of tetanus.^[2] It is on the World Health Organization's List of Essential Medicines.^[12]

Medical uses

Effectiveness

Decrease in tetanus deaths by age group between 1990 and 2017^[13]

Vaccination confers near-complete protection from tetanus, provided the individual has received their recommended booster shots.^[14] 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).^[3][15] 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.^[3] 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.^[16]

Pregnancy

Guidelines on prenatal care in the United States specify that women should receive a dose of the Tdap vaccine during each pregnancy, preferably between weeks 27 and 36, to allow antibody transfer to the fetus.^[5][6] All postpartum women who have not previously received the Tdap vaccine are recommended to get it prior to discharge after delivery.^[17] 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 neonatal tetanus. 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.^[5][6]

Specific types

The first vaccine is given in infancy. The baby is injected with the DTaP vaccine, which is three inactive toxins in one injection. DTaP protects against diphtheria, pertussis, and tetanus. This acellular vaccine is safer than the previously used DTP with whole inactivated pertussis (now retroactively notated DTwP^[18]).^[7] 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.^[14] Quadrivalent, pentavalent, and hexavalent formulations contain DTaP with one or more of the additional vaccines: inactivated polio virus vaccine (IPV), Haemophilus influenzae type b conjugate, Hepatitis B, with the availability varying in different countries.^[19][20][21]

For the every ten-year booster Td or Tdap may be used, though Tdap is more expensive.^[6]

Schedule

Because DTaP and DT are administered to children less than a year old, the recommended location for injection is the anterolateral thigh muscle.^{[medical citation needed]} However, these vaccines can be injected into the deltoid muscle if necessary.^{[medical citation needed]}

The World Health Organization (WHO) recommends six doses in childhood starting at six weeks of age.^[2] Four doses of DTaP are to be given in early childhood.^[14] 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.^[14]

Td and Tdap are for older children, adolescents, and adults and can be injected into the deltoid muscle.^[14] 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.^[22]

Additional doses

Booster shots are important because lymphocyte 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 white blood cells will start to decline. The decline in activity of the T-helper cells means that there must be a booster to help keep the white blood cells active.^[23]

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.^[6]

Tdap is given as a one-time, first-time-only dose that includes the tetanus, diphtheria, and acellular pertussis vaccinations.^[7] This should not be administered to those who are under the age of eleven or over the age of sixty-five.^{[medical citation needed]}

Td is the booster shot given to people over the age of seven and includes the tetanus and diphtheria toxoids. However, Td has less of the diphtheria toxoid, which is why the "d" is lowercase and the "T" is capitalized.^[7]

In 2020, the US Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (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.^[6]

Side effects

A bump resulting from a tetanus vaccine injection

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.^[14][24] Tetanus toxoid containing vaccines (DTaP, DTP, Tdap, Td, DT) may cause brachial neuritis at a rate of one out of every 100,000 to 200,000 doses.^[3][25]

Mechanism of action

The type of vaccination for this disease is called artificial active immunity. This type of immunity is generated when a dead or weakened version of the disease enters the body, causing an immune response which includes the production of antibodies. This is beneficial because it means that if the disease is ever introduced into the body, the immune system will recognize the antigen and produce antibodies more rapidly.^[26]

History

The first vaccine for passive immunology was discovered by a group of German scientists under the leadership of Emil von Behring in 1890. The first inactive tetanus toxoid was discovered and produced in 1924. A more effective adsorbed version of the vaccine, created in 1938, was proven to be successful when it was used to prevent tetanus in the military during World War II.^[14] DTP/DTwP (which is the combined vaccine for diphtheria, tetanus, and pertussis) 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.^[27] Half of those who received the DT(w)P vaccine had redness, swelling, and pain around the injection site,^[14] which convinced researchers to find a replacement vaccine.

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).^[14]

References

1. "Active substance: diphtheria / tetanus vaccines (adsorbed), diphtheria vaccines (adsorbed)" (PDF). List of nationally authorised medicinal products. European Medicines Agency. 14 January 2021.
2. 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.
3. 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.
4. "Puncture wounds: First aid". Mayo Clinic. 4 February 2015. Archived from the original on 8 December 2015. Retrieved 6 December 2015.
5. 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.
6. 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.
7. "Vaccines: VPD-VAC/Tetanus/main page". Centers for Disease Control and Prevention (CDC). Archived from the original on 12 February 2015. Retrieved 10 February 2015. This article incorporates text from this source, which is in the public domain.
8. "Recommended Child and Adolescent Immunization Schedule for ages 18 years or younger, United States, 2020". Centers for Disease Control and Prevention (CDC). 3 February 2020. Retrieved 6 February 2020. This article incorporates text from this source, which is in the public domain.
9. Gradmann C, Simon J (2010). Evaluating and Standardizing Therapeutic Agents, 1890-1950. Springer. p. 53. ISBN 9780230285590.
10. Jones BR (2016). Pharmacology for Student and Pupil Nurses and Students in Associated Professions. Elsevier. p. 162. ISBN 9781483141312.
11. Macera C (2012). Introduction to Epidemiology: Distribution and Determinants of Disease. Nelson Education. p. 251. ISBN 9781285687148. Archived from the original on 5 March 2016.
12. World Health Organization (2023). The selection and use of essential medicines 2023: web annex A: World Health Organization model list of essential medicines: 23rd list (2023). Geneva: World Health Organization. hdl:10665/371090. WHO/MHP/HPS/EML/2023.02.
13. "Deaths from tetanus, by age". Our World in Data. Retrieved 13 January 2020.
14. Centers for Disease Control and Prevention (2011). "Tetanus". Epidemiology and Prevention of Vaccine-Preventable Diseases (CDC, Epidemiology and Prevention of Vaccine-Preventable Diseases) (PDF). Washington, D.C.: Public Health Foundation. ISBN 978-0-01-706609-1. Archived (PDF) from the original on 6 March 2008. Retrieved 4 January 2016. This article incorporates text from this source, which is in the public domain.
15. World Health Organization (9 May 2018). "Tetanus". World Health Organization (WHO). Retrieved 12 January 2020.
16. "About Tetanus". Centers for Disease Control and Prevention (CDC). Archived from the original on 11 November 2014. Retrieved 11 December 2014. This article incorporates text from this source, which is in the public domain.
17. "Pregnancy Guidelines and Recommendations by Vaccine - Tetanus, Diphtheria, and Pertussis (Tdap); & Tetanus and Diphtheria (Td)". Centers for Disease Control and Prevention (CDC). August 2016. Retrieved 15 January 2020. This article incorporates text from this source, which is in the public domain.
18. Syed MA (February 2017). "Choosing from Whole Cell and Acellular Pertussis Vaccines-Dilemma for the Developing Countries". Iranian Journal of Public Health. 46 (2): 272–273. PMC 5402791. PMID 28451568.
19. "2016 Binational Immunization Resource Tool for Children from Birth Through 18 Years" (PDF). Centers for Disease Control and Prevention (CDC). Archived (PDF) from the original on 11 February 2017. Retrieved 22 December 2016. This article incorporates text from this source, which is in the public domain.
20. Centers for Disease Control Prevention (CDC) (October 2008). "Licensure of a diphtheria and tetanus toxoids and acellular pertussis adsorbed, inactivated poliovirus, and haemophilus B conjugate vaccine and guidance for use in infants and children". MMWR Morb. Mortal. Wkly. Rep. 57 (39): 1079–80. PMID 18830213. Archived from the original on 7 November 2016. Retrieved 22 December 2016. This article incorporates text from this source, which is in the public domain.
21. Baldo V, Bonanni P, Castro M, Gabutti G, Franco E, Marchetti F, et al. (2014). "Combined hexavalent diphtheria-tetanus-acellular pertussis-hepatitis B-inactivated poliovirus-Haemophilus influenzae type B vaccine; Infanrix™ hexa: twelve years of experience in Italy". Hum Vaccin Immunother. 10 (1): 129–37. doi:10.4161/hv.26269. PMC 4181021. PMID 24004825.
22. Talbot EA (2010). The Safety of Immunizing with Tetanus–diphtheria–acellular Pertussis Vaccine (Tdap) Less than 2 Years following Previous Tetanus Vaccination: Experience during a Mass Vaccination Campaign of Healthcare Personnel during a Respiratory Illness Outbreak. pp. 8001–7.
23. Veronesi R (1981). Tetanus: Important New Concepts. Amsterdam: Excerpta Medica.
24. "Tdap (Tetanus, Diphtheria, Pertussis) Vaccine Information Statement". U.S. Centers for Disease Control and Prevention (CDC). August 2021. Archived from the original on 28 December 2019. Retrieved 28 December 2019. This article incorporates text from this source, which is in the public domain.
25. "Update: vaccine side effects, adverse reactions, contraindications, and precautions. Recommendations of the Advisory Committee on Immunization Practices (ACIP)" (PDF). MMWR Recomm Rep. 45 (RR-12): 1–35. September 1996. PMID 8801442. This article incorporates text from this source, which is in the public domain.
26. "Vaccines & Immunizations". U.S. Centers for Disease Control and Prevention (CDC). Archived from the original on 22 December 2011. Retrieved 27 November 2011. This article incorporates text from this source, which is in the public domain.
27. "Whooping Cough: Vaccine Combined with Tetanus, Diphtheria". Archived from the original on 6 June 2017. Retrieved 1 May 2017.

Further reading

• Liang JL, Tiwari T, Moro P, Messonnier NE, Reingold A, Sawyer M, et al. (April 2018). "Prevention of Pertussis, Tetanus, and Diphtheria with Vaccines in the United States: Recommendations of the Advisory Committee on Immunization Practices (ACIP)" (PDF). MMWR Recomm Rep. 67 (2): 1–44. doi:10.15585/mmwr.rr6702a1. ISSN 1057-5987. PMC 5919600. PMID 29702631.
• Kahn KE, Black CL, Ding H, Williams WW, Lu PJ, Fiebelkorn AP, et al. (September 2018). "Influenza and Tdap Vaccination Coverage Among Pregnant Women - United States, April 2018" (PDF). MMWR Morb. Mortal. Wkly. Rep. 67 (38): 1055–1059. doi:10.15585/mmwr.mm6738a3. PMC 6188122. PMID 30260946.
• World Health Organization (2018). The immunological basis for immunization series: module 3: tetanus: update 2018. World Health Organization (WHO). hdl:10665/275340. ISBN 9789241513616. License: CC BY-NC-SA 3.0 IGO.
• Ramsay M, ed. (21 January 2021). "Chapter 30: Tetanus". Immunisation against infectious disease. Public Health England.
• Hall E, Wodi AP, Hamborsky J, Morelli V, Schillie S, eds. (2021). "Chapter 21: Tetanus". Epidemiology and Prevention of Vaccine-Preventable Diseases (14th ed.). Washington D.C.: U.S. Centers for Disease Control and Prevention (CDC).
• Roush SW, Baldy LM, Hall MA, eds. (March 2019). "Chapter 16: Tetanus". Manual for the surveillance of vaccine-preventable diseases. Atlanta GA: U.S. Centers for Disease Control and Prevention (CDC).

External links

• "Td (Tetanus, Diphtheria) Vaccine Information Statement". U.S. Centers for Disease Control and Prevention (CDC). August 2021.
• "DTaP (Diphtheria, Tetanus, Pertussis) Vaccine Information Statement". U.S. Centers for Disease Control and Prevention (CDC). August 2021.
• "DTaP/Tdap/Td ACIP Vaccine Recommendations". Centers for Disease Control and Prevention (CDC). 28 January 2020.
• Tetanus Toxoid at the U.S. National Library of Medicine Medical Subject Headings (MeSH)
• Diphtheria-Tetanus Vaccine at the U.S. National Library of Medicine Medical Subject Headings (MeSH)
• Diphtheria-Tetanus-Pertussis Vaccine at the U.S. National Library of Medicine Medical Subject Headings (MeSH)
• Diphtheria-Tetanus-acellular Pertussis Vaccines at the U.S. National Library of Medicine Medical Subject Headings (MeSH)