Tetanus and diphtheria immunization

Abstract

Tetanus and diphtheria are easily preventable diseases that cause significant morbidity and mortality in unvaccinated or inadequately immunized persons. Tetanus is caused by a sporulating bacillus, found in soil and human and animal feces, that may contaminate acute or chronic wounds and release an exotoxin that causes muscle spasms and interferes with release of transmitters in autonomic nerves. Diphtheria is caused by a nonsporulating bacillus, found only in humans, that ordinarily resides in the superficial layers of the respiratory mucosa and in skin lesions and is spread by direct contact with these areas. Active immunization with diphtheria and tetanus toxoids and pertussis vaccine (DTP, whole cell or acellular) is part of the current recommended childhood immunization schedule. Booster doses of tetanus and reduced-dose diphtheria toxoids (Td) are recommended every 10 years following completion of a childhood primary series. For persons beginning a primary series at 7 years of age or older, including adults with uncertain vaccination histories, an initial dose of Td should be followed 4–8 weeks later by a second dose of Td. The second dose should be followed 6–12 months later by a third dose of Td, with booster doses every 10 years thereafter. Vaccine also is indicated for patients recovering from clinical tetanus or diphtheria and for postexposure prevention of tetanus under certain circumstances. The major contraindication to vaccine use is a history of a neurologic or severe hypersensitivity reaction following a prior dose of tetanus and diphtheria toxoids. Among the adverse effects associated with administration of tetanus and diphtheria toxoids are local reactions; mild systemic reactions such as fever, headache, and malaise; and, rarely, more severe systemic reactions, including generalized urticaria, anaphylaxis, and neurologic complications such as Guillain-Barré syndrome (GBS) and brachial neuritis.