What is the recommended dose and administration of TT (Tetanus Toxoid) toxoid?

Tetanus Toxoid Dose and Administration

Primary Vaccination Series

For unvaccinated persons aged ≥7 years, administer a 3-dose series of tetanus and diphtheria toxoid-containing vaccines: the first dose (preferably Tdap), followed by a second dose at least 4 weeks later, and a third dose 6-12 months after the second dose. 1

• Each dose is 0.5 mL administered intramuscularly 2
• The preferred schedule for adults ≥19 years who have never been vaccinated is 1 dose of Tdap, followed by either Td or Tdap ≥4 weeks afterward, and either Td or Tdap 6-12 months later 1
• For children aged 7-18 years who are not fully immunized, give 1 dose of Tdap preferably as the first dose in the catch-up series; if additional doses are required, either Td or Tdap may be used 1
• The vaccination series does not need to be restarted for those with incomplete history, regardless of the time elapsed between doses 1

Booster Immunization

After completing the primary series, routine booster doses of either Td or Tdap should be administered every 10 years throughout adult life. 1, 2

• For persons aged ≥19 years who have never received Tdap, administer 1 dose of Tdap regardless of the interval since the last tetanus-containing vaccine 1
• After receiving Tdap, all subsequent routine boosters should be Td every 10 years 1
• The preferred age for adolescent Tdap is 11-12 years 1

Wound Management Protocol

For contaminated or tetanus-prone wounds, administer a tetanus toxoid-containing vaccine if ≥5 years have elapsed since the last dose; for clean, minor wounds, administer only if ≥10 years have elapsed. 1, 2

Algorithm for Wound Management:

Patients with ≥3 previous doses:

• Clean, minor wounds: Give tetanus toxoid if last dose was ≥10 years ago 3
• Contaminated/tetanus-prone wounds: Give tetanus toxoid if last dose was ≥5 years ago 3
• Tdap is preferred over Td for persons ≥11 years who have not previously received Tdap or whose Tdap history is unknown 1
• No TIG needed 3

Patients with <3 previous doses or unknown history:

• Give both tetanus toxoid-containing vaccine and TIG 250 units IM 3
• Administer at separate anatomic sites using separate syringes 3
• Complete the 3-dose primary series 3

Special Populations

Pregnant Women

Administer Tdap during each pregnancy at 27-36 weeks gestation (preferably during the earlier part of this period), regardless of prior Tdap history. 3

• If a pregnant woman requires a tetanus toxoid-containing vaccine for wound management, Tdap should be used 1
• If >1 dose is needed during pregnancy, either Td or Tdap may be used after the initial Tdap dose 1

Adults ≥65 Years

All adults aged ≥65 years who have never received Tdap should receive a single dose, with Boostrix preferred when feasible, though either product is acceptable. 3

• Administer regardless of the interval since the last tetanus-containing vaccine 3
• After Tdap, continue with Td boosters every 10 years 3

Immunocompromised Patients

Persons with HIV infection or severe immunodeficiency should receive TIG regardless of their tetanus immunization history when they have contaminated wounds. 3

Vaccine Composition and Potency

• Pediatric formulations (DT and DTaP) contain 5-10 Lf units of tetanus toxoid per 0.5 mL dose 1
• Adolescent and adult formulations (Td and Tdap) contain ≤5 Lf units of tetanus toxoid per 0.5 mL dose 1
• All vaccines contain <0.02% formaldehyde and <1.25 mg aluminum 1

Critical Pitfalls to Avoid

Do not administer tetanus boosters more frequently than every 10 years for routine immunization, as this can cause Arthus-type hypersensitivity reactions. 3

• Do not confuse the 10-year routine booster interval with the 5-year interval for contaminated wounds 3
• Do not use DTaP in persons aged ≥7 years; use Tdap or Td instead 1
• Do not restart the vaccination series if doses are delayed; simply continue from where the patient left off 3
• Patients with a history of Arthus reaction should not receive tetanus toxoid-containing vaccine until >10 years after the most recent dose, even for wound management 3

Contraindications and Precautions

Tdap or Td is contraindicated in persons with a history of anaphylaxis to any vaccine component. 1

• Tdap is contraindicated in persons with a history of encephalopathy within 7 days of administration of a pertussis vaccine not attributable to another identifiable cause; these persons should receive Td instead 1
• Guillain-Barré syndrome ≤6 weeks after a previous dose of tetanus toxoid is a precaution 1