Is a middle-aged female patient with mildly elevated blood pressure (hypertension) and no subjective complaints eligible for Tetanus toxoid vaccine and Rabies vaccination?

Eligibility for Tetanus and Rabies Vaccination with Elevated Blood Pressure

Yes, this patient is eligible for both tetanus toxoid vaccine and rabies vaccination—mildly elevated blood pressure (156/82 mmHg) is neither a contraindication nor a precaution for either vaccine. 1

Contraindications and Precautions for Tetanus Toxoid Vaccination

Absolute contraindications to tetanus toxoid-containing vaccines include only:

• History of serious allergic reaction (anaphylaxis) to any vaccine component 1
• History of encephalopathy within 7 days of previous pertussis-containing vaccine (contraindication for Tdap only, not Td) 1

Precautions that warrant careful risk-benefit evaluation include:

• Guillain-Barré syndrome within 6 weeks of previous tetanus toxoid dose 1
• Moderate or severe acute illness with or without fever (defer until illness resolves) 1
• History of Arthus reaction after previous tetanus/diphtheria toxoid dose 1
• Unstable neurologic conditions 1

Conditions that are NOT contraindications or precautions include:

• Stable neurologic disorders, including well-controlled seizures 1
• Immunosuppression or HIV infection 1
• Breastfeeding 1
• Minor intercurrent illness 1
• Hypertension or elevated blood pressure (not mentioned as contraindication in any guideline) 1

Contraindications and Precautions for Rabies Vaccination

The ACIP guidelines for rabies vaccination specify even fewer contraindications:

No absolute contraindications exist for rabies post-exposure prophylaxis because of the invariably fatal nature of rabies once symptoms develop. 1

Precautions include:

• Immunosuppression (may require serologic testing to confirm adequate antibody response) 1
• Pregnancy (not a contraindication; prophylaxis should be administered with awareness that immune response may be adequate) 1

Hypertension is explicitly not mentioned as a contraindication or precaution for rabies vaccination. 1

Clinical Context: Hypertension and Vaccination

The blood pressure of 156/82 mmHg represents Stage 1 hypertension (systolic 130-139 or diastolic 80-89 mmHg), but this is not considered "moderate or severe acute illness" that would warrant deferring vaccination. 1

One case report documented hypertensive anaphylaxis (blood pressure 197/153 mmHg) as a rare presentation of vaccine-related anaphylaxis, but this occurred acutely after vaccination, not as a pre-existing condition. 2 Pre-existing hypertension does not increase risk for this rare reaction.

Practical Recommendations

For this patient:

• Administer tetanus toxoid vaccine (Td or Tdap) as clinically indicated 1
• Administer rabies vaccination as clinically indicated (pre-exposure or post-exposure prophylaxis) 1
• Observe patient for 15 minutes post-vaccination to monitor for syncope or allergic reactions 1
• Have epinephrine 1:1,000 immediately available for management of potential anaphylaxis 3

Common pitfall to avoid: Do not confuse asymptomatic chronic conditions like hypertension with "moderate or severe acute illness," which refers to conditions like pneumonia, acute gastroenteritis, or other illnesses that would make the patient acutely unwell. 1 The patient has "no subjective complaints," confirming absence of acute illness.