Questions & Answers

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When did tetanus vaccine become available?
The first tetanus toxoid (inactivated toxin) was produced in 1924 and was used successfully to prevent tetanus in the armed services during World War II. In the mid-1940s, tetanus vaccine was combined with diphtheria toxoid and inactivated pertussis vaccine to make the combination DTP vaccine for routine childhood immunization.

In 1991, the first DTaP product was licensed. It substituted an acellular form of the pertussis component for the whole-cell pertussis component. The pertussis component of this vaccine is a more purified "acellular" version, which produces fewer side effects.

In 2005, two new tetanus toxoid and diphtheria toxoids with acellular pertussis vaccine (Tdap) products were licensed. These vaccines are the first pertussis-containing vaccines that can be given to persons older than 7 years.

What kind of vaccine is the tetanus toxoid?
The tetanus vaccine is an inactivated toxin (poison) called a toxoid. It is made by growing the bacteria in a liquid medium and purifying and inactivating the toxin. Because it is not a live vaccine, a person's immunity tends to decline with time, which is why booster doses are recommended.

What's the difference between all the vaccines containing tetanus toxoid?
It's like alphabet soup! Tetanus toxoid is available as a single shot (TT) but is rarely given that way as it's best to also provide needed protection against other diseases at the same time. Tetanus toxoid can be combined with diphtheria toxoid as DT (for children younger than age 7 years) or as Td (for persons age 7 years and older). It can also be combined with diphtheria and pertussis as DTaP (for children younger than age 7 years) or as Tdap (for persons ages 10 through 64 years). Lastly, DTaP is also part of four childhood combination vaccines that include other vaccines (e.g., IPV, Hib, HepB).

How is this vaccine given?
The DTaP, DT, Td, and Tdap preparations are all given as an injection in the anterolateral thigh muscle (for infants and young toddlers) or in the deltoid muscle (for older children and adults).

Who should get this vaccine?
All infants and children should receive tetanus toxoid as part of their DTaP/Tdap vaccine series. Adults should be given routine booster doses of Td every 10 years. Adults without documentation of ever receiving the basic series of tetanus and diphtheria toxoids should first receive a primary series of three doses, properly spaced. A single dose of Tdap is recommended for persons age 11 years and older in place of one of the Td doses, preferably the first one.

How many doses of DTaP vaccine are needed?
The usual schedule for infants is a series of four doses given at two, four, six, and 15-18 months of age. A fifth shot, or booster dose, is recommended at 4-6 years of age, unless the fourth dose was given late (after the fourth birthday).

When should adolescents and adults get vaccinated against tetanus? Should they get vaccinated with Td or Tdap?
Immunization experts recommend that the first dose of Tdap be given at age 11-12 as a booster during the routine adolescent immunization visit if the adolescent has finished the childhood DTaP schedule and has not already received a dose of Td or Tdap.

Adults should continue to receive a booster dose of Td every ten years. Adults age 19-64 years who have never received Tdap should receive a single dose of Tdap to replace a single dose of Td so they can boost their resistance to pertussis as well. Adults who will be having close contact with an infant should receive Tdap vaccine even if they’ve recently received Td vaccine (see pertussis vaccine section for more information).

If someone experiences a deep or puncture wound, or a wound contaminated with dirt, an additional booster dose may be given if the last dose was more than five years ago. It is important to keep an up-to-date record of all immunizations so that repeat doses don't become necessary. Although it is vital to be adequately protected against tetanus, receiving more doses than recommended can lead to increased local reactions, such as painful swelling of the arm.

Who recommends this vaccine?
The Centers for Disease Control and Prevention (CDC), the American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP), and the American College of Physicians (ACP) all recommend this vaccine.

How safe is this vaccine?
Most children have no serious reactions from the combined DTaP vaccine. The most common reactions are local reactions at the injection site, such as soreness, redness, and swelling, especially after the fifth dose. Other possible reactions may include fussiness, fever, loss of appetite, tiredness, and vomiting. The use of the more purified DTaP instead of DTP has decreased these reactions substantially.

For adults receiving Td vaccine, localized non-serious side effects are common (redness, soreness, etc.) but are generally self-limiting and require no treatment.

What side effects have been reported with this vaccine?
Moderate to serious reactions are uncommon with DTaP vaccine. Such reactions include crying for three hours or more (up to about one child out of 1,000) and high fever (about one child out of 16,000). Most of these side effects are believed to be due to the pertussis component of the vaccine, and a child experiencing such a reaction may still be able to be protected against tetanus and diphtheria with the DT vaccine. More serious reactions, such as seizures, are so rare that it is hard to tell if they are caused by the vaccine.

As mentioned above, adults who received more than the recommended doses of Td vaccine can experience increased local reactions, such as painful swelling of the arm. This is due to the high levels of tetanus antibody in their blood.

The most frequently reported side effects following vaccination with Tdap were headache, generalized body aches, and tiredness.

Some of my patients describe having had a severe reaction to something they were given for tetanus many years ago. What could this be?
The allergic reactions these people experienced may have actually been serum sickness, a reaction to equine antitoxin. Equine antitoxin was the only product available for the prevention of tetanus prior to the mid 1940s. It was used for postexposure prophylaxis until the late 1950s, when tetanus immune globulin was introduced. Tetanus toxoid has never contained any horse protein.

How effective is tetanus-diphtheria toxoid (Td)?
Td is close to 100% effective for persons receiving the correct primary series (as a child or adult) and a routine booster dose every ten years. It is felt that Tdap vaccine will provide the same level of protection.

Who should NOT receive tetanus toxoid?
People who had a serious allergic reaction to a vaccine component or a prior dose of tetanus toxoid should not receive another.

Persons with a moderate or severe acute illness should postpone receiving the vaccine until they are improved. Most reactions to the combined DTaP vaccine are due to the pertussis component. Please see the "Pertussis" section for more information on possible precautions to the use of this vaccine.

Can the vaccine cause tetanus?
No. The vaccine is a toxoid, meaning it is a toxin that has been inactivated, and has demonstrated safety in numerous clinical trials.

Questions and answers about tetanus disease

Technically reviewed by the Centers for Disease Control and Prevention, February 2009