Tetanus Immunisation

What is tetanus?

Tetanus is a serious infection which affects the nerves, and is often fatal. Tetanus bacteria (germs) live in the soil and dirt. The bacteria may get into your body through a cut or a wound in the skin. The bacteria make a toxin (poison) which causes the illness.

Even small wounds such as a prick from a thorn can allow enough bacteria to get into the body to cause tetanus. The illness takes up to 21 days to develop, sometimes more. Therefore, you may have forgotten about a small cut before the illness starts.

The vaccine

• For young children, tetanus vaccine is normally part of the combined DTP-Polio-Hib vaccine (diphtheria/tetanus/pertussis/polio/haemophilus influenzae b vaccine) which is given as part of the routine childhood immunisation programme.
• For adults and teenagers who receive tetanus immunisation, a combined tetanus/diphtheria/polio vaccine (Td-Polio) is normally used.

The vaccine stimulates your body to make antibodies against the tetanus toxin. These antibodies protect you from illness should you become infected with this bacteria.

Tetanus immunisation timetable

All children are offered tetanus immunisation as part of the routine immunisation programme. A full course of tetanus immunisation consists of five doses of vaccine as follows:

The primary course of three injections gives good protection for a number of years. The fourth and fifth doses ('boosters') maintain protection. After the fifth dose, immunity remains for life and you do not need any further boosters (apart from some travel situations - see below).

Adults - are you immunised?

Some adults have not been fully immunised against tetanus because routine immunisation for children was not introduced until 1961. Men serving in the armed forces from 1938 onwards were offered tetanus immunisation. So, some older people may still be at risk. (Between 1984 and 1995 there were 145 cases of tetanus in England and Wales - mainly in older people.)

See your practice nurse if you think that you are not fully immunised against tetanus (that is - if you have not had five injections in total). The course does not need to be started again if an injection is delayed. A late injection is sufficient to 'catch up', even if you have it years after it was due.

Do I need a dose of tetanus vaccine after cuts, bites, etc?

• If you are not immunised or up-to-date with boosters then an injection of vaccine is usually advised. Also, a tetanus antiserum may also be advised if the wound is dirty and 'tetanus prone'. (The antiserum contains antibodies which can protect against tetanus bacteria, but it is not a vaccine.)
• If you are up-to-date with tetanus immunisations, then you do not need a tetanus vaccine. (However, tetanus antiserum may be advised if the wound is particularly dirty and a lot of tetanus bacteria are likely to have got into the wound. For example, if the wound is contaminated with stable manure. The antiserum provides additional protection to your own immunity from previous immunisation.)

I am going abroad - do I need a tetanus immunisation?

Usually not if you are up-to-date with your immunisations. However, if you are to travel to areas where medical attention may not be available, then a dose of vaccine may be advised. This is even if you have had five previous injections. In particular, if it has been more than 10 years since your last injection. This is a precautionary measure in case you have a very dirty wound and do not receive antiserum. Your doctor or practice nurse will advise.

Are there any side-effects from the tetanus vaccine?

It is common to get a little redness and swelling around the injection site which goes after a few days. Some people feel slightly unwell for a day or so with a mild headache, slight aching of the muscles, and a mild fever. Some people get reactions to the injection if they have more than the recommended number, or have a dose of vaccine too early. Severe reactions are rare.

If you are unwell with an illness causing a fever, it is wise to postpone an injection until the illness has gone (except if the dose is needed after a cut or wound). Also, you should not have another injection of vaccine if a previous injection caused a severe reaction. The risk to pregnant women from the vaccine is likely to be small, but it is better to play safe. Therefore, if possible, delay immunisation until after the pregnancy.

Further information

Information on immunisation
www.immunisation.org.uk
From the NHS aimed at the general public.

Immunisation Against Infectious Disease (The Green Book)
www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/GreenBook/fs/en
From the Department of Health. Aimed at health professionals but of interest to all.

© EMIS and PIP 2006   Updated: September 2006

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