All About Tetanus Shots

Who Needs Them and Who Doesn't

The tetanus vaccine is used to prevent tetanus. It is given as a combination shot along with the diphtheria and pertussis (whooping cough) vaccines. The tetanus vaccine is delivered in one of four forms:

  • DT, given to children 2 months to 6 years to prevent diphtheria and tetanus
  • DTaP, given to children 2 months to 6 years to prevent diphtheria, tetanus, and pertussis
  • Tdap, given to children age 7 and older and to adults to prevent all three diseases
  • Td, a booster shot used to boost immunity against tetanus and diphtheria
A close-up of a person receiving a injection into their arm
Iab Wooten / Getty Images

Diseases Treated

The Td, DT, DTaP, and Tdap vaccines have different indications for use and treat specific infectious bacterial diseases.

Tetanus is a bacterial infection of the nervous system, also known as lockjaw. Symptoms include muscle stiffness, difficulty swallowing, muscle spasms, and seizures. Death occurs in approximately 10% to 20% of those infected, but the rate of death is highest among the elderly.

Diphtheria is a bacterial infection that causes a thick covering on the back of the throat. It can lead to breathing problems, heart failure, paralysis, and death. Vaccination of diphtheria has all but eliminated the disease in the United States.

Pertussis is a bacterial infection also known as whooping cough. It can cause severe coughing spells and vomiting as well as difficulty speaking and breathing. Up to 5% of adolescents and adults who have pertussis either experience severe complications or are hospitalized.

Recommendations

Vaccine recommendations in the United States are issued by a panel of experts within the Centers for Disease Control and Prevention (CDC) called the Advisory Committee on Immunization Practices (ACIP).

DTaP Vaccination

The DTaP vaccine is delivered by intramuscular injection in a 0.5-mL dose and given five times between the ages of 2 months and 4 to 6 years. ACIP recommends the following immunization schedule:

  • 2 months
  • 4 months
  • 6 months
  • 15 to 18 months
  • 4 to 6 years

Can DTaP Cause Brain Disease?

Historically, there was concern that the pertussis vaccine could cause a brain disease called encephalopathy. Although evidence supported the possibility, this was never proven. Furthermore, the risk was associated with the whole-cell pertussis vaccine—not the acellular pertussis vaccine used in DTaP.

The United States switched from the whole-cell pertussis vaccine to the acellular pertussis vaccine in the 1990s due to this and other safety concerns.

DT Vaccination

DT is used in the same way as the DTaP vaccine. However, it is only used in children who should not get pertussis vaccines, such as those who have had a severe allergic reaction to a dose of DTaP.

Parents should remember, though, that children vaccinated with DT are only protected against diphtheria and tetanus, not whooping cough.

Tdap and Td Vaccinations

After 6 years of age, your child ages out of the DTaP vaccine and will receive the Tdap vaccine.

Delivered by injection in a 0.5-mL dose, the Tdap vaccine is used routinely as a booster in children ages 11 to 12. It can also be used as a catch-up vaccination in kids who never got their primary series of shots.

It is given in a single dose in adults with no history of receiving Tdap.

In addition, all adults will need a booster shot every 10 years. This may be Tdap or the Td vaccine, so long as they have received Tdap in the past; if not, at least one booster should be Tdap.

Tdap differs from DTaP in the size of the dose of each of the three vaccines. With Tdap, the tetanus dose is the same as DTaP but the diphtheria and pertussis doses are smaller.

One Tdap dose is also recommended during each pregnancy regardless of when someone was last vaccinated against tentanus.

The Td or Tdap vaccine, also administered by intramuscular injection in a 0.5 milliliter (mL) dose, is also recommended for anyone who has an injury or wound that could possibly cause tetanus who has not had a tetanus vaccine of any kind in the past five years.

Side Effects

The majority of people who receive a tetanus vaccine experience mild side effects that resolve within a day or two. Many will have no side effects at all.

Common side effects of all formulations include:

  • Injection site soreness, redness, or swelling
  • Muscle aches
  • Mild fever
  • Headache
  • Fatigue

In rare cases, the vaccine may cause a potentially life-threatening whole-body allergy known as anaphylaxis.

Precautions and Contraindications

There are certain people in whom the Td, Tdap, DT, or DTaP vaccine should be avoided, namely anyone who has had a previous anaphylactic reaction to the vaccine or any of its components.

Moreover, it is important to speak with your doctor about the benefits and risks of vaccination if:

  • You have an unstable neurological condition.
  • You have a moderate or severe illness at the time of vaccination.
  • You have ever had Guillain-Barre syndrome after receiving any vaccine.
  • You have ever had a severe reaction to a vaccine before.
  • You are pregnant (particularly if during your first trimester).

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Article Sources
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  1. Centers for Disease Control and Prevention. Diphtheria, tetanus, and pertussis vaccines. Updated September 9, 2020.

  2. Centers for Disease Control and Prevention. Tetanus: For clinicians. Updated January 23, 2020.

  3. Centers for Disease Control and Prevention. Diphtheria. Updated January 19, 2021.

  4. Kilgore PE, Salim AM, Zervos MJ, Schmitt HJ. Pertussis: Microbiology, disease, treatment, and prevention. Clin Microbiol Rev. 2016;29(3):449-86. doi:10.1128/CMR.00083-15

  5. Liang JL, Tiwari T, Moro P, et al. Prevention of pertussis, tetanus, and diphtheria with vaccines in the United States: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. 2018;67(2):1-44. doi:10.15585/mmwr.rr6702a1

  6. Klein NP. Licensed pertussis vaccines in the United States: history and current state. Hum Vaccin Immunother. 2014 Sep;10(9):2684-90. doi:10.4161/hv.29576

  7. Centers for Disease Control and Prevention. Diphtheria, tetanus, and whooping cough vaccination: What everyone should know. Updated January 22, 2020.

  8. Centers for Disease Control and Prevention. Pertussis: Summary of vaccine recommendations. Updated January 2020.

  9. Havers FP, Moro PL, Hunter P, Hariri S, Bernstein H. Use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccines: Updated recommendations of the Advisory Committee on Immunization Practices — United States, 2019. MMWR. 2020;69:77-83. doi:10.15585/mmwr.mm6903a5

  10. McNeil MM, Weintraub ES, Duffy J, et al. Risk of anaphylaxis after vaccination in children and adults. J Allergy Clin Immunol. 2016 Mar;137(3):868-78. doi:10.1016/j.jaci.2015.07.048