Tetanus Prevention

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  • All children should be vaccinated against tetanus during routine childhood immunization using the DPT-HepB-Hib vaccine at 6, 10, and 14 weeks of age (see above)
  • Neonatal tetanus is prevented by routinely immunising all pregnant women/women of child- bearing age (15–45 years) against tetanus with Tetanus Toxoid vaccine (see below)
Prophylaxis Against Neonatal Tetanus
  • Ensure hygienic deliveries, including proper cutting and care of umbilical cords through the use of skilled birth attendants
  • Immunise all pregnant women/women of child- bearing age (15 – 45 years) against tetanus with Tetanus Toxoid vaccine (TT)
  • Give TT vaccine 0.5 mL IM into the upper arm as per the recommended schedule below:

Routine TT vaccine schedule and the period of protection

 

TT DOSE

 

WHEN GIVEN

DURATION AND LEVELS OF PROTECTION

TT1

At first contact with woman of childbearing age or as early as possible during pregnancy

None

TT2

At least 4 weeks after TT1

3 years; 80% protection

TT3

At least 6 months after TT2

5 years; 95% protection

TT4

At least 1 year after TT3

10 years; 99% protection

TT5

At least 1 year after TT4

30 years; 99% protection
Vaccination Against Adult Tetanus
  • High risk groups such as farm workers, military personnel, miners, safe male circumcision clients, should be vaccinated as in the table above (if not fully immunized) and given regular boosters every 10 years
  • Patients at risk of tetanus as a result of contaminated wounds, bites, burns, and victims of road traffic accidents be given Antitetanus Immunoglobulin (TIG) and then be vaccinated as indicated in the table below

TREATMENT

General measures

  • Ensure adequate surgical toilet and proper care of wounds

Passive immunization: give to any patient at risk, except if fully immunized and having had a booster within the last 10 years

  • Give IM tetanus immunoglobulin human (TIG):
    • Child <5 years: 75 IU
    • Child 5-10 years: 125 IU
    • Child >10 years/adult: 250 IU
  • Double the dose if heavy contamination suspected or if >24 hours since injury was sustained

Alternative - only if TIG not available:

  • Antitetanus serum (tetanus antitoxin) 1,500 IU deep SC or IM

Active immunization

Unimmunised or partially immunised patients:

  • Give a full course of vaccination for those who are not immunized at all (3 doses 0.5 mL IM at intervals of 4 weeks)

Fully immunized patients with booster >10 years before:

  • Give one booster dose of TT 0.5 mL intramuscularly

Fully immunised patients who have had a booster dose within the last 10 years

  • A booster is NOT necessary

Note:

  • Giving TIG or TT to a fully immunised person may cause an unpleasant reaction, e.g., redness, itching, swelling, and fever, but with a severe injury this is justified