Managing Tetanus Shot Reactions
If you experience a reaction to a tetanus shot, treatment should be based on the type and severity of the reaction, with most common local reactions managed with supportive care and severe reactions requiring immediate medical attention. 1
Types of Tetanus Shot Reactions and Management
Mild Local Reactions (Most Common)
- Redness, pain, tenderness, and mild swelling at injection site - occurs in up to 95% of recipients 1, 2
- Management:
- Apply cool compresses to reduce swelling and discomfort
- Take acetaminophen or NSAIDs for pain relief
- Monitor the site - these reactions typically resolve within 1-2 days without intervention
Moderate Local Reactions
- Significant swelling, warmth, and increased pain at the injection site
- Management:
- Continue supportive care with cool compresses
- Take over-the-counter pain relievers
- Elevate the affected limb if possible
- Monitor for improvement within 24-48 hours
Arthus Reactions (Rare)
- Severe local reactions starting 2-8 hours after injection
- Characterized by severe pain, swelling, induration, edema, hemorrhage, and occasionally necrosis
- Often associated with fever and malaise
- Typically occurs in persons who have received multiple boosters of tetanus toxoid 1
- Management:
- Seek medical attention
- Note: Persons who experience Arthus reactions usually have high serum tetanus antitoxin levels and should not receive tetanus-containing vaccines more frequently than every 10 years 1
Systemic Reactions
- Fever, malaise, headache, and lymphadenopathy - less common than local reactions 1, 2
- Management:
- Rest and adequate hydration
- Acetaminophen for fever and discomfort
- Seek medical attention if symptoms persist beyond 48 hours
Severe Allergic Reactions (Very Rare)
- Generalized urticaria, anaphylaxis - extremely rare but life-threatening 1
- Management:
- SEEK EMERGENCY MEDICAL CARE IMMEDIATELY
- If you have an epinephrine auto-injector, use it as directed
- Call emergency services (911)
- Lie flat with legs elevated unless experiencing breathing difficulties
Neurological Reactions (Extremely Rare)
- Peripheral neuropathy, brachial neuritis, Guillain-Barré syndrome (GBS)
- Management:
- Seek immediate medical attention
- Note: GBS occurring within 6 weeks after tetanus vaccination is considered a precaution for subsequent doses 1
When to Seek Medical Attention
Seek immediate medical care if you experience:
- Difficulty breathing, wheezing, or throat tightness
- Swelling of face, lips, tongue, or throat
- Widespread hives or rash
- Severe dizziness or weakness
- Neurological symptoms (numbness, weakness, tingling)
- High fever (>103°F/39.4°C)
- Severe pain or swelling extending beyond the injection site
Future Vaccination Considerations
- History of local reactions only: These do not preclude future tetanus vaccination 1
- History of Arthus reaction: Avoid tetanus-containing vaccines more frequently than every 10 years 1
- History of severe allergic reaction: This is a contraindication to future tetanus vaccination 1
- Intradermal skin testing with appropriately diluted tetanus toxoid may be useful before deciding to discontinue tetanus vaccination completely 1
- History of GBS: Decision to administer additional doses should be based on weighing benefits versus risks 1
Important Caveats
- Most reactions to tetanus vaccines are mild and self-limiting
- The risk of complications from tetanus disease far outweighs the risk of vaccine reactions for most people
- If you have experienced a previous severe reaction, inform healthcare providers before receiving future tetanus-containing vaccines
- Document the specific type of reaction experienced for future reference
- For pregnant women, tetanus vaccination is considered safe, though waiting until the second trimester is a reasonable precaution 1