All About Tetanus Shots

Who Needs Them and Who Doesn't

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The tetanus vaccine is used to prevent tetanus. It can be given as a stand-alone shot or as a combination shot along with the diphtheria and/or pertussis (whooping cough) vaccines. The tetanus vaccine is delivered in one of three forms:

  • Td, a booster shot used to boost immunity against tetanus and diphtheria
  • DTaP, given to children 6 weeks to 6 years to prevent diphtheria, tetanus, and pertussis
  • Tdap, given to people 10 through 64 years to prevent the same three diseases
A close-up of a person receiving a injection into their arm

Iab Wooten / Getty Images

Diseases Treated

The Td, 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.

The tetanus and diphtheria vaccines were both developed in the 1920s, followed by the rubella vaccine in 1971.

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).

Td Vaccination

The Td vaccine is administered by intramuscular injection in a 0.5 milliliter (mL) dose. According to the current ACIP recommendations:

  • All adults who have not been previously been immunized with at least three doses of tetanus and diphtheria vaccine should be vaccinated for tetanus.
  • Anyone who has an injury or wound that could possibly cause tetanus who has not had a vaccine in the past five years should also be vaccinated.
  • All adults should also have a Td booster every 10 years.

If you have never had a tetanus vaccine, you will need three doses of Td. For adults between 18 and 64, one of those three doses may be substituted with Tdap.

DTaP Vaccination

 The DTaP vaccine is also delivered by 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

Tdap Vaccination

After 6 years of age, your child ages out of the DTaP vaccine and will receive the Tdap vaccine. Also delivered by the injection in a 0.5-mL dose, the Tdap vaccine is given three times over the course of six to 12 months in children and as a single dose in adults.

Among those who should receive the Tdap vaccine are:

  • Children between 7 and 10 years who were not fully vaccinated with DTaP
  • Children between 11 and 18 years (ideally between 11 and 12 years)
  • Adults 19 and older as a one-time dose, followed by a Td or Tdap booster every 10 years
  • Pregnant women between 27 and 36 weeks of gestation
  • Seniors over 65 if they are in close contact with a newborn or an infant under 12 months
  • Healthcare workers who have not previously received the Tdap vaccine

The DTaP vaccine differs from Tdap in that it contains full-strength doses of all three vaccines. The Tdap vaccine uses a full-strength dose of the TD vaccine but smaller doses of diphtheria and pertussis.

Side Effects

The overwhelming majority of people who receive the 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 the Td vaccine 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. It is an extremely rare side effect occurring at a rate of  0.001% of all Td vaccine recipients.

When to Call 911

Call 911 or go to your nearest emergency room if you experience some or all of the following after receiving the Td vaccine:

If left untreated, anaphylaxis can lead to shock, coma, asphyxiation, respiratory or heart failure, or death.

Contraindications

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

Similarly, the Td vaccine should be avoided in anyone who experienced encephalopathy within seven days of receiving the DTaP or Tdap vaccine.

It is important to discuss the benefits and risks of Td vaccination with your doctor 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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