Tetanus Toxoid (Injection, Intramuscular)

Tetanus Toxoid is an injection that can be given to help protect people against the tetanus infection that used to occur quite frequently because of the universality of the culprit bacteria in nature.

Overview

Tetanus is an infection that has brought pain and morbidity to many people since at least the 5th century. However, P. Descombey and Gaston Ramon discovered Tetanus Toxoid in 1924 and the combat against the disease began in earnest during the second world war.

It is an inactive vaccine that is given in a series of doses in order to allow the passive effects to take hold within the human body and reduce the chance of tetanus being able to manifest. It used to be that a plethora of people were being infected and about 10% of these would end up dying, but as recently as 2015, the death toll has been reduced to about 59,000, and that is a figure that is significantly less than once was.

In Tetanus Toxoid, the dead or weakened version of the bacterium Clostridium tetani is introduced into the body of the person receiving the immunization so that the toxicity will not cause the harmful effects, but there will still be an immune response that allows the body to be able to formulate the antibodies necessary to fight back if the person ever encounters the full version of that bacterium. This is known in medicine as artificial active immunity. The World Health Organization's List of Essential Medicines now includes the vaccine because of the fact that it has been able to reduce the prevalence of tetanus to only 5% of what it used to be in years past.

A person is given the initial regimen of doses, usually in childhood when possible, and then should later receive a booster dose at an interval of about 10 years in order to maintain the effectiveness necessary in order to avoid symptoms if exposed. In general, Tetanus Toxoid is a safe vaccine that can be used even in women who are pregnant, children, or those with somewhat compromised immune responses due to HIV/AIDS. It is also included in some of the combinatorial vaccinations such as DTaP and DT or Tdap and Td. These combinations can have diphtheria and pertussis (the whooping cough) vaccines interwoven in order to reduce the number of shots needed.

Tetanus Toxoid has been so successful that the existence of the disease within the United States, and other developed countries, has become practically negligible. Further, even in the few people who still become infected, the death rate has significantly dropped so that only about 10% of those cases lead to a fatality.

Treated Conditions

  • Tetanus or lockjaw

Type of Medicine

  • TT injectable vaccine or booster shots

Side Effects

The most common side effects that might manifest when a person is given this injection is a redness or swelling around the shot site that is also usually painful and tender to the touch. Sometimes there may also be an accompanying fever, tiredness, or body aches following the introduction of Tetanus Toxoid. Td/Tdap administration has been known to sometimes cause a more serious swelling, which may include the entire arm where the shot was received, and the occurrence frequency of this side effect is about one in 500.

A severe allergic reaction, or anaphylaxis, is a very rare side effect, but it still does happen about once every 100,000 vaccinations. A person experiencing this type of allergic reaction may have a strain to breathe, face swelling, or hives throughout the body. The booster vaccine or subsequent shots should not be received if a person does experience this type of allergic reaction due to the life-threatening potential.

Dosage

Infants are generally given the combination vaccine that includes the Tetanus Toxoid at birth. Because of this, maternal and neonatal tetanus has been eliminated in many countries by reducing the number of deaths to less than one in every 1,000 live births. That is the definition of elimination according to the World Health Organization, but the disease cannot be eradicated like smallpox or polio due to the prevalence of the bacteria throughout the world.

Five childhood doses is the usual regimen that is utilized to first help with the initial immunization, and then a sixth injection is given during adolescence. After this, adults need a booster shot at an interval of every 10 years in order to maintain the level of lymphocyte production that will allow the body to combat tetanus. Also, a booster shot is given to those patients who have recently experienced an injury that is high-risk for tetanus, and this includes severe cuts and related issues. Overdoses of the absorbed Tetanus Toxoid vaccine are highly unlikely to occur, but the proper schedule should still be adhered to.

Drug Interactions

There are 182 drugs that are known to interact with Tetanus Toxoid, and the general complication is a reduced immune response to the vaccine. In many cases, a doctor may wait until the person has finished a regimen of one of the drugs before giving TT doses.

Some of the most vital interactions are in regards to drugs or treatments that might weaken the immune system, and if a patient is currently in the process of taking one of these or in the midst of a treatment, then the vaccination administration may have to wait. These immune weakening medications include steroids (oral, injectable, nasal, or inhaled), radiation cancer treatment, autoimmune disorder drugs such as leflunomide (Arava), azathioprine (Imuran), and etanercept (Enbrel), or organ transplant rejection drugs.

Warnings

There is various medical literature that suggests that a Tetanus Toxoid vaccine should only be given to pregnant women if the need for such protection is urgent enough that it outweighs the alternative of waiting until after birth and the postpartum period. Certain disorders and medical conditions are generally used to exclude children from this vaccine if they have experienced one in the past, and these include Guillain-Barre Syndrome, blood disorders such as low platelets or hemophilia, high fevers or reactions in response to previous tetanus vaccine doses, and certain immune or nervous system disorders.

The toxoid solution may contain thiomersal, which is a preservative for vaccines, and it is important that anyone that is known to have a hypersensitivity to the organomercury compound not take it. Latex hypersensitivity might also be a contraindication in some variations such as the multidose vial form. The tetanus infection generally comes with an incubation period of between 10 days up to a couple of months, and if any signs of an active infection are seen, then it is likely best to treat it using other measures rather than solely with tetanus toxoid.

Storage

Proper keeping of caches of the toxoid should be maintained at a temperature of between 2 and 8 degrees Celsius (35 - 46 degrees Fahrenheit), but TT should not be frozen.

Summary

The Tetanus Toxoid formulation is ideal for use as a primary immunization method in children under the age of seven, and it can be utilized as a booster dose in those who are over that age. It has been effective at basically eliminating maternal and neonatal variations of the infection in many countries, but there are some remaining that still encounter quite a few instances in live births, and so the World Health Organization is continuously working to help these affected areas. No vaccine is 100% effective, and so tetanus is still possible even in those who have received a regimen. The toxoid is often given in combination with diphtheria with acellular pertussis vaccines since the launch of newer variants (TDaP or DTaP) happened in 1992. Some mild side effects are quite common, and these include things like a fever or irritation at the injection site, but there is the slight possibility of a larger and life-threatening reaction about once in 100,000 administrations. The drug is used universally in humans, and it can also be used by veterinarians and others in order to help limit the occurrence of the condition in various types of animals such as horses, other livestock, and domestic species as well.

Childhood doses should be administered on a schedule that specifies six total doses, and then there are booster versions of the shot that will be given at an interval of ten years in order to help solidify the body's defenses. It was previously thought that five years was a threshold that would nullify the efficacy of booster shots, but it is known the general consensus that a viable antibody response is still likely to occur even up to ten years after the basic (childhood) immunization. Yet, after a decade the response is generally less than desired, and so it is important that adults try to maintain their tetanus shots as much as possible. This is especially true for world travelers of the developing world or those who are likely to encounter the infection through their employment or other high-risk endeavors. Anyone who has experienced a wound that has involved necrotic and dead tissue or a wound where a foreign object had become embedded should definitely pursue a booster shot in order to help limit the chance of tetanus in their body. Any burns that are either the second-degree or third-degree variety hold a higher risk than the first-degree counterparts, and puncture wounds are also quite vulnerable so that the booster should be administered. Since the bacteria generally thrives in dust, soil, and manure, any person who has received a wound that was visibily covered with such material should also seek a booster for immunity response. In general, this is an excellent product to be used as a prevention mechanism, but it is not viable for use against an active infection, and there are a variety of other measures that might be taken such as tetanus immune globulin and muscle relaxants to help deal with the spasms that often accompany the infection.

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Last Reviewed:
December 23, 2017
Last Updated:
April 05, 2018
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