Tetanus Toxoid
Overview And Preparation
- Inactivated by formalin and adsorbed onto aluminum salts to enhance immunogenicity.
- Single dose contains 5 limit of flocculation (Lf) of toxoid.
- Confers active immunity and generates immune memory requiring periodic boosters.
- Administered via intramuscular route, preferring anterolateral thigh for infants and deltoid for older children.
- Available widely in combinations like diphtheria, tetanus, whole-cell pertussis (DTwP), diphtheria, tetanus, acellular pertussis (DTaP), tetanus and reduced diphtheria (Td), and pentavalent vaccines.
Immunization Schedule
Routine Childhood And Adolescent Immunization
| Age Group | Recommended Schedule | Preferred Formulation |
|---|---|---|
| Infants | 6, 10, and 14 weeks | Pentavalent or hexavalent combinations |
| Toddlers | 15-18 months (first booster) | DTwP or DTaP combinations |
| Children | 4-6 years (second booster) | DTwP or DTaP combinations |
| Adolescents | 10-12 years | Tdap |
| Adults | Every 10 years | Td or Tdap |
Maternal Immunization
- Routine immunization during pregnancy declines neonatal tetanus incidence.
- Provides Passive Immunity to newborn via transplacental passage of immunoglobulin G (IgG) antibodies.
- Recommend single dose of Tdap during each pregnancy, preferably between 27 and 36 weeks.
- Unimmunized pregnant women require two doses, including one Tdap, administered at least 1 month apart, with second dose at least 2 weeks before delivery.
Wound Management Prophylaxis
- Tetanus toxoid and tetanus immunoglobulin (TIG) indications depend on wound severity and previous vaccination status.
| Previous Vaccine Doses | Clean Minor Wound | All Other Wounds |
|---|---|---|
| Unknown or <3 doses | Vaccine yes, TIG no | Vaccine yes, TIG yes |
| >=3 doses, <5 years ago | Vaccine no, TIG no | Vaccine no, TIG no |
| >=3 doses, 5-10 years ago | Vaccine no, TIG no | Vaccine yes, TIG no |
| >=3 doses, >10 years ago | Vaccine yes, TIG no | Vaccine yes, TIG no |
- Administer Tdap or Td for children >7 years needing wound prophylaxis.
- Provide catch-up vaccination with three doses at 0, 1, and 6 months for completely unimmunized individuals.
Efficacy And Storage
Protective Efficacy
- Vaccine efficacy varies between 80% and 100%.
- Protective antitoxin level defined as 0.01 IU/mL.
- Protection level depends on toxin load during exposure.
Storage Conditions
- Heat stable vaccine, remains potent for few weeks even at 37°C.
- Ideal storage temperature maintained strictly at 2-8°C.
- Freezing strictly contraindicated; accidentally frozen vaccine must be discarded immediately.
Adverse Effects And Contraindications
- Common minor reactions include local pain, swelling, and redness at injection site.
- Systemic effects like fever and headache observed infrequently.
- Absolute contraindication includes severe allergic reaction or anaphylaxis following prior dose.