The Green book on immunisation – chapter 30 tetanus
The combined vaccines should be used where protection is required against tetanus,
diphtheria or polio in order to provide comprehensive long-term protection against all
three diseases. This topic is to explore what is needed for travel. More information can be found on NaThnac.
A little bit about tetanus
Tetanus is an acute disease caused by the action of tetanus toxin released following
infection by the bacterium Clostridium tetani. Tetanus spores are present in soil or manure
and may be introduced into the body through a puncture wound, burn or scratch – which
may go unnoticed. The bacteria grow anaerobically at the site of the injury and have an
incubation period of between four and 21 days (most commonly about ten days).
The disease is characterised by generalised rigidity and spasms of skeletal muscles. The
muscle stiffness usually involves the jaw (lockjaw) and neck and then becomes generalised.
The case–fatality ratio ranges from 10 to 90%; it is highest in infants and the elderly.
Tetanus can never be eradicated because the spores are commonly present in the
environment, including soil.
Tetanus is not spread from person to person.
Neonatal tetanus is an important cause of death in some countries in Africa due to
infection of the baby’s umbilical stump.
The tetanus vaccination
Tetanus vaccines used for primary immunisation contain not less than 40IU of tetanus
toxoid; vaccines used for boosters contain not less than 20IU. The tetanus vaccine is only
given as part of combined products for the UK national vaccination programme:
● diphtheria/tetanus/acellular pertussis/inactivated polio vaccine/Haemophilus influenzae
type b/Hepatitis B (DTaP/IPV/Hib/HepB)
● diphtheria/tetanus/acellular pertussis/inactivated polio vaccine (DTaP/IPV or dTaP/IPV)
● tetanus/diphtheria/inactivated polio vaccine (Td/IPV)
Dosage and schedule
● first dose of 0.5ml of a tetanus-containing vaccine
● second dose of 0.5ml, one month after the first dose
● third dose of 0.5ml, one month after the second dose
● fourth and fifth doses of 0.5ml should be given at the recommended intervals
Travellers and those going to reside abroad
All travellers should ensure that they are fully immunised according to the UK schedule (see
above). Additional doses of vaccines may be required according to the destination and the
nature of travel intended (see NaTHNaC).
For travellers to areas where medical attention may not be accessible and whose last dose
of a tetanus-containing vaccine was more than ten years previously, a booster dose should
be given prior to travelling, even if the individual has received five doses of vaccine
previously. This is a precautionary measure in case immunoglobulin is not available to the
individual in the event of a tetanus-prone injury.
Where tetanus, diphtheria or polio protection is required and the final dose of the relevant
antigen was received more than ten years ago, Td/IPV should be given.
Minor illnesses without fever or systemic upset are not valid reasons to postpone
If an individual is acutely unwell, immunisation should be postponed until they have fully
recovered. This is to avoid wrongly attributing any new symptom or the progression of
symptoms to the vaccine.