Tetanus Toxoid Injection Administration
The standard dose of tetanus toxoid (TT) injection is 0.5 mL administered intramuscularly, preferably into the deltoid muscle for adults and children aged ≥3 years, or the anterolateral thigh for infants and children through age 2 years. 1, 2
Dosing Specifications
- Volume: 0.5 mL per dose for all tetanus toxoid-containing vaccines (Tdap, Td, TT, or DT) 1, 2
- This dose is standardized across all age groups and formulations 1, 2
Administration Route and Technique
Intramuscular Injection Sites
- Adults and children ≥3 years: Deltoid muscle is the preferred site 1, 2
- Infants and children ≤2 years: Anterolateral aspect of the thigh is preferred 1
- Never administer subcutaneously as the standard route, as intramuscular administration produces significantly fewer local reactions (less redness, swelling, itching, and pain) compared to subcutaneous injection 3
Key Technical Points
- Use appropriate needle length to ensure true intramuscular delivery 1
- Administer as a single 0.5 mL injection 1, 2
- When multiple vaccines are indicated, use separate syringes at different anatomic sites, with at least one inch separation if injecting into the same muscle 1
Vaccination Schedule Context
Primary Series (Previously Unvaccinated)
- Three-dose series: First two doses administered 4-8 weeks apart, third dose 6-12 months after the second dose 1, 4, 2
- Each dose is 0.5 mL intramuscularly 1, 2
Booster Doses
- Routine boosters: Every 10 years throughout life after completing primary series 4, 2
- Wound management: May administer booster if ≥5 years have elapsed since last dose for contaminated/tetanus-prone wounds 1, 5, 2
- Same 0.5 mL intramuscular dose applies 1
Vaccine Selection Considerations
- Tdap preferred over Td for persons aged ≥11 years who have not previously received Tdap, to provide pertussis protection 1, 4
- Td or TT for subsequent boosters or when Tdap is contraindicated 1, 4
- DT (0.5 mL IM) for children <7 years when pertussis component is contraindicated 1
Common Pitfalls to Avoid
- Do not use subcutaneous route for routine administration, as this increases local reactions significantly 3
- Do not alter the 0.5 mL dose - this is standardized regardless of age or indication 1, 2
- Do not administer in the gluteal region - deltoid or thigh are the only recommended sites 1
- Do not give boosters more frequently than every 10 years for routine immunization to avoid Arthus-type hypersensitivity reactions 1, 4
Special Circumstances
When TIG is Also Needed
- Administer tetanus immune globulin (TIG) 250 units IM in a separate syringe at a different anatomic site when indicated for wound management in incompletely vaccinated patients 1, 5
- The tetanus toxoid dose remains 0.5 mL IM 1, 5
Pregnancy
- Same 0.5 mL intramuscular dose of Tdap administered between 27-36 weeks' gestation during each pregnancy 4