Everything you’ve ever wanted to know (and dared to ask) about the tetanus vaccine (in children and adults)

What is Tetanus?

Tetanus is a condition that is caused by a bacterial toxin called Clostridium tetani. The bacteria usually replicate within cuts and bruises and release toxins into the bloodstream that lead to unpleasant symptoms.

Fortunately, thanks to the vaccine, the prevalence of the disease around the world is quite low and in most developed countries an infectious disease specialist will only see a rare case of Tetanus once every few years.

What vaccines exist for Tetanus?

First of all, one should understand the difference between an active vaccine and a passive vaccine.

Active vaccine – an intramuscular injection of antigens (proteins), that cause the body to produce antibodies against the pathogen. In an active vaccine, the body is active and produces the antibodies itself. All the scheduled childhood vaccines are active vaccines.

Passive vaccine – an intramuscular injection of antibodies that was collected from donors. In a passive vaccine, the body remains passive and receives antibodies without the need to produce them itself.

Passive vaccines are given for certain diseases, usually after exposure to an infection (when the body doesn’t have time to produce antibodies itself).

What type of active vaccines do we have for Tetanus?

A vaccine only for Tetanus – used in very special cases.

The bivalent vaccine – contains Diphtheria and Tetanus. There’s a pediatric dose and an adult dose.

The trivalent vaccine – contains Diphtheria, Tetanus and Pertussis.

The quadrivalent vaccine – contains Diphtheria, Tetanus, Pertussis and inactivated Polio.

The pentavalent vaccine – contains Diphtheria, Tetanus, Pertussis, inactivated Polio, Haemophilus influenzae type B.

The Hexavalent vaccine – contains Diphtheria, Tetanus, Pertussis, inactivated Polio, Haemophilus influenzae type B and Hepatitis B virus.

How are Tetanus vaccines scheduled?

In most countries in the world, children receive Tetanus immunizations at the following times:

Pentavalent (or the Hexavalent) vaccine – 2 months, 4 months, 6 months and at 15-18 months.

Quadrivalent vaccine – at ages 4 through 6 years.

Trivalent vaccine – at ages 11 or 12 years.

In addition, in many countries, every pregnant women receives the trivalent vaccine on the 30^th week of gestation. Read more about vaccines during pregnancy here.

And theoretically speaking, a booster is recommended every 10 years for all adults.

What are active Tetanus vaccine side effects?

Mainly tenderness at the site of injection, including local redness and swelling.

If it happens that I vaccinate someone with two different vaccines, each on a different arm, it is very obvious the next day which arm received the Tetanus shot as it is by far more painful.

Pay attention though, giving repetitive and unnecessary doses of the Tetanus vaccine can bring about a surplus of local side effects, especially tenderness at the site of injection.

So, what needs to be done after an injury?

First of all, prevention of Tetanus after an injury starts with early treatment of the wound, including, cleansing and decontamination.

Next, the need for vaccine (whether active, passive or both), is to be determined. This decision is based on whether the injury was minor or not and on whether the person is fully vaccinated against Tetanus or not.

A minor injury is defined as a superficial injury (less that 1 cm deep), without signs of infections or signs of local tissue destruction, and after having been treated within 6 hours of onset of injury.

Any other injury that doesn’t fall into the above category will be considered a non-minor injury, including wounds that are deeper than 1 cm, wounds accompanied by destruction of local tissue, unclean wounds (contaminated with dirt, earth, feces, saliva etc.), wounds not given treatment within 6 hours, burn wounds, bites, snake bites, ischemic wounds, contaminated miscarriages and contaminated livebirths (ones that occurred without the care of a midwife).

Who is considered fully vaccinated against Tetanus? A person who has received at least 3 doses of Tetanus vaccine at the appropriate timings.

Who is not considered fully vaccinated against Tetanus? A person who received 2 or less doses of vaccine.

Who decides who gets what?

The decision is based on the type of wound (minor/other) and the person’s vaccine status (whether or not they’re fully vaccinated with 3 doses) as follows:

A fully vaccinated individual (having taken 3 vaccines or more in the past) –

For a minor wound a booster vaccine is required (active vaccine) if it has been over 10 years since the person’s last vaccine.

For all other wounds – a booster is required if it has been over 5 years since the person’s last vaccine.

An unvaccinated individual (anyone who has received 2 vaccines or less) or cases where the vaccine status is unknown –

For a minor wound – an active vaccine is to be given immediately and the person’s regular vaccine course should be completed afterwards.

For any other wound – both a passive vaccine (immunoglobulins) and an active vaccine should be given immediately, and the person’s vaccine schedule should be completed.

An active and passive vaccine can be given together.

Remember, a child should not receive more than 6 vaccines by the age of 8.

What is the paradox about anti-vaxxers?

I’ve seen this happen several times. Anti-vaxxers do not vaccinate their children or themselves with the Tetanus vaccine for all sorts of reasons but after an injury you find them running to the emergency room to get their immunoglobulins.

You would think that if you don’t like having proteins pushed into your body you also wouldn’t want to receive antibodies from human donors…

What’s the story with the Pertussis vaccine?

As I mentioned earlier, as adults we are expected to receive the Tetanus booster every 10 years, and more importantly, after injuries.

Many emergency clinics give the bivalent vaccine (Diphtheria and Tetanus).

If we could have received the trivalent vaccine that includes Pertussis too, we would have been better off as there is quite a lot of pertussis going around these days and we really are supposed to be getting the pertussis vaccine once every 10 years, as well.

Therefore, if you haven’t recently received the pertussis vaccine and you are scheduled to receive the Tetanus shot soon, try to get the one that has the pertussis vaccine in it as well – win – win.

What about children that need to get vaccinated after an injury?

I get asked about this a lot.

Let’s look at an example. A child in first grade, who is six and a half years old and was last vaccinated for Tetanus as part of the pentavalent vaccine at the age of 1. Say, for example, he just got injured and now needs to receive a Tetanus shot (because it has been over 5 years since his last Tetanus vaccine and because the injury wasn’t minor). But, he/she are scheduled to receive the quadrivalent vaccine in a year that includes polio as well. What should he/she do?

Theoretically speaking, if we were able to give this child the quadrivalent vaccine at this point, it would have been best. The problem is that the quadrivalent vaccine is difficult to get a hold of. So, we give whatever’s available.

Notice that in the above scenario, only a child who suffered an injury that doesn’t fall under the “minor” category would require a Tetanus shot, otherwise the child would be able to wait for his quadrivalent vaccine. This is also true to the period of time between the vaccines at age 7-8 and the ones at the age of 11 or 12.

To summarize, I hope this post will answer your questions and will help you get the right vaccine at the right time.