From the Guidelines
A tetanus booster should be administered every 10 years for adults who have completed their primary vaccination series, or immediately if a person sustains a deep, dirty, or contaminated wound and it has been more than 5 years since their last tetanus shot, as recommended by the Advisory Committee on Immunization Practices (ACIP) 1.
Key Points to Consider
- For individuals who have never been vaccinated against tetanus, a complete primary series should be given, with the standard tetanus booster used in adults being Td (tetanus and diphtheria) or Tdap (tetanus, diphtheria, and pertussis) 1.
- Pregnant women should receive a Tdap vaccine during each pregnancy, preferably between 27 and 36 weeks gestation, to prevent pertussis in infants too young for routine vaccination 1.
- For wound management, tetanus immune globulin may also be given alongside the vaccine for high-risk wounds in patients with unknown or incomplete vaccination history, as the bacterium commonly enters the body through wounds contaminated with soil, dust, or animal feces 1.
- The updated recommendations from the ACIP in 2019 allow for the use of either Td or Tdap in situations where previously only Td was recommended, increasing provider point-of-care flexibility 1.
Important Considerations for Specific Populations
- Adults who have never received Tdap should receive a booster dose of Tdap, and women are recommended to receive a dose of Tdap during each pregnancy 1.
- Pediatric patients with uncertain vaccination history should receive a tetanus booster according to the standard childhood immunization schedule, with DTaP if aged <7 years, Td if aged 7–10 years, and Tdap if aged >11 years 1.
From the FDA Drug Label
To ensure continued protection, booster doses of Td should be given every 10 years. Available evidence indicates that complete primary vaccination with tetanus toxoid provides long lasting protection ≥10 years for most recipients. Consequently, after complete primary tetanus vaccination, boosters-even for wound management-need be given only every 10 years when wounds are minor and uncontaminated For other wounds, a booster is appropriate if the patient has not received tetanus toxoid within the preceding 5 years.
A tetanus (Td) booster is indicated:
- Every 10 years for continued protection
- For other wounds (not minor and uncontaminated), if the patient has not received tetanus toxoid within the preceding 5 years 2 2
From the Research
Indications for Tetanus (Td) Booster
- A tetanus (Td) booster is indicated for adults if it has been more than 10 years since their last immunization 3, 4, 5.
- The booster is not required unless there are plans for the injured patient to travel to diphtheria-prone countries in the future, as the incidence of diphtheria is negligible in the United States 3.
- Tetanus immunoglobulin should be reserved for patients with wounds who had never received primary immunization against tetanus 3.
- Some studies suggest that a single booster at age 65 may be a cost-effective alternative to decennial boosters 6.
- The durability of vaccine-induced immunity against tetanus and diphtheria toxins has been found to be longer than previously thought, with estimated half-lives of 14 years for tetanus and 27 years for diphtheria, suggesting that booster vaccinations may not be necessary every 10 years 7.
Special Considerations
- The majority of vaccinees attain protective tetanus immunity under a proper vaccination schedule, even in older persons 4.
- Decennial boosters are recommended for elderly persons who have received primary tetanus vaccination in the past 4.
- Clinical decision support alerts can help reduce potentially unnecessary tetanus vaccinations in the emergency department 5.