Tetanus Vaccination Recommendations for Elderly Individuals
Elderly individuals should receive a tetanus booster dose (either Td or Tdap) every 10 years throughout life to maintain protection against tetanus. 1
General Recommendations for Adults ≥65 Years
- For elderly individuals who have previously received a primary vaccination series, booster doses of either Td (tetanus and diphtheria toxoids) or Tdap (tetanus, diphtheria, and acellular pertussis) should be administered every 10 years to ensure continued protection 1
- If an elderly person has never received Tdap, they should receive one dose of Tdap regardless of the interval since their last tetanus or diphtheria toxoid-containing vaccine 1
- After receiving one dose of Tdap, either Td or Tdap can be used for subsequent booster doses every 10 years 1
Catch-up Vaccination for Elderly with Incomplete/Unknown History
- Elderly individuals with unknown or uncertain previous tetanus vaccination histories should be considered to have had no previous tetanus toxoid doses 1, 2
- For elderly persons who have never been vaccinated against tetanus, diphtheria, or pertussis, a series of three tetanus and diphtheria toxoid-containing vaccines is recommended 1:
- First dose: Tdap
- Second dose: Either Td or Tdap at least 4 weeks after first dose
- Third dose: Either Td or Tdap 6-12 months after second dose
Special Considerations for Elderly
- Older adults have lower prevalence of protective antibody levels against tetanus (45% of men and only 21% of women aged >70 years) 2
- Elderly patients represent a disproportionate burden of tetanus cases, with 38% of reported cases occurring in those aged ≥65 years 2
- The case-fatality ratio for tetanus remains high (8-18%) even with modern medical care, with higher rates among elderly patients 2
Wound Management in Elderly
- For clean, minor wounds, tetanus toxoid-containing vaccine is indicated if >10 years have passed since the last dose 1, 2
- For contaminated or tetanus-prone wounds, tetanus toxoid-containing vaccine is indicated if >5 years have passed since the last dose 1
- If a tetanus toxoid-containing vaccine is indicated for wound management in an elderly person who has never received Tdap, Tdap is preferred 1
- For elderly individuals with documentation of previous Tdap vaccination, either Td or Tdap may be used if a tetanus toxoid-containing vaccine is indicated for wound management 1
- For elderly patients with tetanus-prone wounds who have not completed a primary vaccination series, Tetanus Immune Globulin (TIG) should be administered along with tetanus toxoid-containing vaccine 2, 3
Efficacy in Elderly
- Despite waning immunity with increasing age, the majority of elderly vaccinees attain protective tetanus immunity under a proper vaccination schedule 4
- Most elderly individuals will develop an adequate anti-tetanus antibody titer following administration of a single dose of tetanus vaccine, particularly those with a history of past immunization 5
Common Pitfalls in Tetanus Vaccination for Elderly
- Underestimating the importance of tetanus vaccination in elderly individuals, who are at higher risk for tetanus infection and mortality 2
- Failing to recognize that a history of past immunization is a good predictor of developing adequate antibody titers after vaccination 5
- Misunderstanding that tetanus toxoid administration in the acute injury setting provides protection against the next injury, not the current injury 6
- Overuse of Tetanus Immune Globulin (TIG) in patients who have previously completed primary immunization 6
The updated ACIP recommendations from 2019 provide greater flexibility by allowing either Td or Tdap to be used for decennial booster doses, which may improve compliance with tetanus vaccination schedules in the elderly population 1.