Current Tetanus Vaccination Protocol in India
Primary Vaccination Series
India follows the WHO-recommended Universal Immunization Programme (UIP) which includes tetanus toxoid as part of the pentavalent DTP vaccine (diphtheria, pertussis, tetanus, hepatitis B, and Hib) administered in childhood, with subsequent boosters throughout life. 1, 2
Childhood Schedule
- Primary series: Three doses of pentavalent DTP vaccine at 6 weeks, 10 weeks, and 14 weeks of age 2
- First booster: DTP at 16-24 months of age 1
- Second booster: DT (diphtheria-tetanus) at 5-6 years of age 1
Adolescent and Adult Schedule
- Tdap dose: Single dose at 10-12 years of age (preferred timing 11-12 years) 1, 3
- Adult boosters: Td or Tdap every 10 years throughout life 1, 4
Special Populations
Pregnant Women
Every pregnant woman should receive one dose of Tdap during each pregnancy, regardless of prior vaccination history, administered between 27-36 weeks of gestation (preferably in the earlier part of this window). 1, 5
- This provides passive antibody transfer to protect newborns during their vulnerable first 2-3 months before they begin their own vaccine series 5
- Tdap can be safely given at any time during pregnancy if needed for wound management or outbreak situations 5
Adults Who Missed Primary Immunization
Adults in India who missed their primary immunization should receive a three-dose series: one dose of Tdap, followed by Td at least 4 weeks later, and a third dose of Td 6-12 months after the second dose. 6, 7
- Research from India shows that 78% of unvaccinated adults had some tetanus immunity but only 9% had long-term diphtheria protection, and only 60% were immune to pertussis 7
- After three doses of Td vaccine, long-term immunity increased to 87% for tetanus and 97% for diphtheria 7
Wound Management Protocol
Clean, Minor Wounds
- No tetanus toxoid needed if last dose was within 10 years 6, 4
- Tdap preferred (if not previously received) or Td if last dose was >10 years ago 6
Contaminated or Severe Wounds
- Tetanus toxoid needed if last dose was >5 years ago 6, 4
- Tdap preferred (if not previously received and >5 years since last tetanus vaccine) or Td 6
- Tetanus Immune Globulin (TIG) 250 units IM required if patient has not completed primary series (unknown or <3 doses) 6
- When both TIG and tetanus toxoid are indicated, administer in separate syringes at different anatomic sites 6
Unknown or Incomplete Vaccination History
Persons with unknown or uncertain vaccination histories should be considered to have had no previous tetanus toxoid doses and require both tetanus toxoid and TIG for contaminated/severe wounds. 6
Important Clinical Considerations
Contraindications
- Absolute contraindication: History of neurologic or severe hypersensitivity/anaphylactic reaction to previous dose 6
- Arthus-type hypersensitivity: Do not give tetanus toxoid until >10 years after most recent dose, even for contaminated wounds; use TIG only 6
Common Pitfalls to Avoid
- Do not use DTaP in persons ≥7 years of age; use Tdap or Td instead 1
- Do not restart the vaccination series if doses are delayed; simply continue from where the patient left off 1, 4
- Do not give tetanus boosters more frequently than every 10 years for routine immunization (5 years for contaminated wounds) to avoid Arthus reactions 6
- Do not miss opportunities to vaccinate adults during acute care visits, as many Indian adults remain susceptible to diphtheria 7
Safety Profile
- Minor local reactions (soreness, redness, swelling) and mild fever are common and not contraindications to continued vaccination 6, 7
- Pregnancy is not a contraindication; tetanus and diphtheria toxoids are not teratogenic 6, 5
Context-Specific Challenges in India
Research indicates that in rural India, DPT vaccination coverage faces both demand-side and supply-side barriers 8:
- Children whose mothers have no schooling are 2.3 times more likely not to receive any DPT vaccination 8
- Village- and district-level healthcare infrastructure significantly impacts initial vaccination but has less effect on dropout rates 8
- Despite 93% of children receiving at least one vaccine, only 75% complete the three-dose DPT series 8