VACCINE INFORMATION
There are 4 forms of tetanus immunization. See also diphtheria immunization (vaccine) and pertussis immunization (vaccine).

The DTaP vaccine is a "3-in-1" vaccine that protects against diphtheria, pertussis, and tetanus. It can be given to children less than 7 years old. It is injected, usually into the arm or the thigh. DTaP is a safer version of an older vaccine known as DTP, which is no longer used in the United States.

The DT vaccine is a "2-in-1" vaccine that can be given to children less than 7 years old. It does not contain pertussis vaccine, but does contain vaccine that protects against diphtheria and tetanus. It is injected, usually into the arm or thigh.

The Td vaccine is the "adult" vaccine. It is a "2-in-1" vaccine that protects against tetanus and diphtheria. It contains a slightly different dose of diphtheria vaccine than the DT vaccine. It can be given to anyone older than 7 years old. It is injected, usually into the arm.

Tetanus vaccine (T vaccine) can be given as a single vaccine, but this is not generally available. It is also injected, usually into the arm.

Tetanus immune globulin is not actually a vaccine. It is a preparation that is made from serum (part of the blood) from a person or animal (such as a horse) that contains antibodies against tetanus.

It provides immediate, short-term protection against the disorder, but does not provide long-term immunization. It can be used when someone is believed to have been exposed to the bacteria -- such as when a person steps on a rusty nail or gets cut outdoors in a situation where soil may have entered the wound.

IMMUNIZATION SCHEDULE
Tetanus vaccination is one of the recommended childhood immunizations and should begin during infancy. Tetanus immunization is generally required before starting school. Five doses of vaccine are recommended.

DTaP or DT immunization is usually a series of injections given to children at ages 2 months, 4 months, 6 months, and 15 to 18 months. A booster is given before starting school (age 4 to 6).

DTaP is recommended, unless there is a reason that the child should not receive the pertussis vaccine (such as allergic reaction), in which case the DT should be given.

After the initial series of immunizations, a booster of Td vaccine should be given at age 11 to 12 and every 10 years thereafter.

T vaccine or a Td booster may be given to an adult receiving care for a wound or injury that breaks the skin. Typically, a booster is given if the wound is dirty and the last Td booster was given more than 5 years prior to the injury.

BENEFITS
Nearly all people who receive a minimum of 3 injections of tetanus-containing vaccine will be protected against the disorder for at least 10 years.

DTaP and DT vaccine can be safely given to infants.

RISKS
It is much riskier to get tetanus than it is to get the vaccine. Mild reactions to DTaP are fairly common and include:

• Slight fever (occurs in about 1 in 4 people)
• Redness or swelling at the injection site (about 1 in 4)
• Soreness or tenderness where the shot was given (about 1 in 4)
• Fussiness (up to 1 in 3)
• Tiredness or poor appetite (up to 1 in 10)
• Swelling of the entire arm or leg where the shot was given for 1-7 days (about 1 in 30)
• Vomiting (around 1 in 50)

Moderate problems are uncommon and include:

• Crying nonstop for 3 hours or more (1 in 1,000)
• Seizures (1 in 14,000)
• High fever greater than 105 degrees F (1 in 16,000)

Severe problems are very rare and include:

• Serious allergic reaction (less than once per one million doses)
• Long-term seizures, coma, lowered consciousness, permanent brain damage (extremely rare and not proven to have been caused by the vaccine)

As with any medications or any vaccine, there is a chance of other serious complications, including death. This is rare after tetanus immunization. For almost all people, the benefits of vaccination far outweigh the risks.

DELAY OR DO NOT GIVE (CONTRAINDICATIONS)
If a child is sick with something more serious than a mild cold, DTaP may be delayed until the child is better.

If a child has had any of the following after an earlier DTaP, consult with the health care provider before the child receives another injection of the vaccine:

• Seizures within 3-7 days after injection
• Any serious brain problem within 7 days after injection
• Worsening of seizures or other brain problem (at any time)
• Mouth, throat, or face swelling (serious allergy) within a few hours after injection
• Difficulty breathing (serious allergy) within a few hours after injection
• Temperature of 105 degrees F or higher within 2 days after injection
• Shock or collapse within 2 days after injection
• Persistent, uncontrolled crying that lasts for more than 3 hours at a time within 2 days after injection

POSTIMMUNIZATION SYMPTOMS AND CARE
The provider who gives the tetanus immunization may recommend measures to reduce normal postimmunization symptoms. Acetaminophen may be recommended to reduce fever and soreness.

Some providers recommend a dose be given just prior to the injection to help avert common, minor side effects. Warmth (such as a warm, damp cloth or a heating pad) may reduce soreness. Frequently moving or using the arm or leg that has received the injection is recommended and often reduces the soreness.

Adults who receive the Td or T vaccine (particularly if received more often than every 10 years) may experience soreness and swelling at the injection site, lasting for 2 or 3 days.

CALL THE PRIMARY HEALTH CARE PROVIDER IF

• Uncertain whether tetanus-containing immunization should be given (see delay or contraindications).
• Complications or severe symptoms develop after tetanus immunization, including seizures; fever above 105 degrees F; difficulty breathing; or other signs of allergy, shock, or collapse; or uncontrolled crying that lasts for more than 3 hours at a time.
• Other symptoms develop after the tetanus immunization.
• There are other questions or concerns about tetanus immunization.