What are the current protocols for tetanus (Tetanus Toxoid) vaccination and booster shots?

Current Protocols for Tetanus Vaccination

The current protocol for tetanus vaccination includes a primary immunization series followed by booster doses every 10 years, with Tdap (tetanus, diphtheria, and acellular pertussis) replacing one of the Td (tetanus and diphtheria) boosters in adolescents and adults. 1

Primary Immunization

Children Under 7 Years

• Primary series consists of 5 doses of DTaP (diphtheria, tetanus, and acellular pertussis) vaccine administered at:
  • 2 months
  • 4 months
  • 6 months
  • 15-18 months
  • 4-6 years 1

Persons 7 Years and Older (Never Vaccinated)

• Series of three tetanus-containing vaccines:
  • First dose: Tdap (preferred)
  • Second dose: Either Td or Tdap (≥4 weeks after first dose)
  • Third dose: Either Td or Tdap (6-12 months after second dose) 1

Booster Doses

Routine Boosters

• Adolescents (11-12 years): One dose of Tdap regardless of interval since last tetanus-containing vaccine 1, 2
• Adults: Tetanus-containing booster (Td or Tdap) every 10 years 1, 3
• Either Td or Tdap can be used for routine 10-year boosters (updated 2019 recommendation) 1

Special Situations

Wound Management

• For clean, minor wounds:

  • No tetanus toxoid needed if <10 years since last dose
  • Td or Tdap if ≥10 years since last dose 3

• For contaminated or tetanus-prone wounds:

  • No tetanus toxoid needed if <5 years since last dose
  • Td or Tdap if ≥5 years since last dose 3
  • Tetanus Immune Globulin (TIG) should be administered for persons with unknown vaccination history or <3 doses of tetanus toxoid 3

Pregnancy

• One dose of Tdap during each pregnancy, preferably between 27-36 weeks gestation 1, 4
• If not previously vaccinated or last dose was >10 years ago, a booster dose is recommended to prevent neonatal tetanus 1

Updated Recommendations (2019-2020)

• Either Td or Tdap can be used for:

  • Decennial (10-year) booster doses
  • Tetanus prophylaxis for wound management
  • Additional doses in the catch-up immunization schedule 1

• This change increases provider flexibility and simplifies immunization recommendations 1

Special Considerations

• No minimum interval is required between Td and Tdap administration 1
• If DTaP is inadvertently administered to a person ≥7 years old, it should count as the Tdap dose 1
• For persons aged ≥65 years, either Tdap product (Boostrix or Adacel) is considered valid, though Boostrix is FDA-approved for this age group 1, 5

Common Pitfalls and Caveats

• Tetanus infection does not confer natural immunity, so vaccination is essential even after recovery from tetanus disease 6
• More frequent administration of tetanus toxoid-containing vaccines than recommended may increase the risk of adverse reactions, including Arthus-type hypersensitivity reactions 3
• Despite declining incidence in the United States, tetanus remains a risk, particularly for older adults and those with diabetes 7
• The majority of tetanus cases occur in inadequately vaccinated individuals or those with unknown vaccination history 7

Remember that tetanus is almost 100% preventable with proper immunization, and no deaths have been reported among patients who were up-to-date with their tetanus vaccination 8, 7.