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Tetanus vaccine

From Wikipedia, the free encyclopedia

Tetanus vaccine, also known as


tetanus toxoid (TT), is an inactive Tetanus vaccine
vaccine used to prevent tetanus.[1] Vaccine description
During childhood five doses are Target Tetanus
recommended, with a sixth given during disease
adolescence.[1] Additional doses every Type Toxoid
10 years are recommended.[2] After
three doses almost everyone is initially Clinical data
immune.[1] In those who are not up to MedlinePlus a682198
date on their tetanus immunization a (https://medlineplus.gov/druginfo/meds/a682198.html)
booster should be given within 48 hours
ATC code J07AM01 (WHO
of an injury.[3] In those with high risk
injuries who are not fully immunized (https://www.whocc.no/atc_ddd_index/?
tetanus antitoxin may also be code=J07AM01))
recommended.[1] Making sure women Identifiers
who are pregnant are up to date on their
ChemSpider none
tetanus immunization and, if not,
immunizing them can prevent neonatal (what is this?) (verify)
tetanus.[1]

The vaccine is very safe including during pregnancy and in those with HIV/AIDS.[1] Redness and pain at
the site of injection occur in between 25% and 85% of people.[1] Fever, feeling tired, and minor muscles
pains occur in less than 10% of people.[1] Severe allergic reactions occur in less than one in 100,000
people.[1]

A number of vaccine combinations include the tetanus vaccine such as DTaP and Tdap which contain
diphtheria, tetanus, and pertussis vaccine, and DT and Td which contain diphtheria and tetanus vaccine.
[4]
DTaP and DT are given to children less than seven years old while Tdap and Td are given to those
seven years old and older.[4] The lowercase d and p denote lower strengths of diphtheria and pertussis
vaccines.[4]

The tetanus vaccine was developed in 1924 and became available in the United States in the 1940s.[1][5]
Its use resulted in a 95% decrease in the rate of tetanus.[1] It is on the World Health Organization's List
of Essential Medicines, the most effective and safe medicines needed in a health system.[6] The
wholesale cost in the developing world is between 0.17 and 0.65 USD per dose as of 2014.[7] In the
United States a course of tetanus vaccine is between 25 and 50 USD.[8]

Contents
1 Medical uses
1.1 Pregnancy
1.2 Specific types
1.3 Schedule
2 Side effects
3 Mechanism of action
4 History
5 References

Medical uses
Since the discovery and productions of the tetanus vaccines, the occurrence of tetanus, diphtheria, and
pertussis has decreased. Using US population derived figures, following vaccination, 95% of people are
protected from diphtheria, 80% to 85% of people are protected from pertussis, and 100% of people are
protected from tetanus.[9] Before the vaccine there was an average of 580 annual cases of tetanus and
472 annual deaths from tetanus. But since the vaccine there is an average of 41 annual cases of tetanus
and 4 annual deaths from tetanus. This is 93% reduction in occurrence of tetanus and a 99% reduction in
fatalities resulting from tetanus.[9]

Tetanus has become uncommon in the United States, with an average of 29 reported cases per year from
1996 through 2009. Nearly all cases of tetanus are among those who have never received a tetanus
vaccine, or adults who don't stay up to date on their 10-year booster shots.[10]

Pregnancy

Guidelines on prenatal care in the United States state that, if an urgent need for tetanus protection occurs
during pregnancy, Td vaccine should be administered.[11] If no urgent need arises and the woman has
previously received tetanus vaccine, Td vaccination should be delayed until the postpartum period.[11]
All postpartum women who have not received Td or Tdap vaccine in the last two years are
recommended to receive Tdap prior to discharge after delivery.[11] It is recommended for pregnant
women who have never received tetanus vaccine (i.e., have never received DTP, DTaP or DT as child or
Td or TT as adult) to receive a series of three Td vaccinations starting during pregnancy to ensure
protection against maternal and neonatal tetanus.[11] In such cases, administration of Tdap is
recommended after 20 weeks' gestation,[12] and in earlier pregnancy a single dose of Tdap can be
substituted for one dose of Td, and then the series completed with Td.[11]

Specific types

The first vaccine is administered at infancy. The baby is injected with the DTaP vaccine which is 3
inactive toxins in one injection. DTaP protects against diphtheria, pertussis, and tetanus. This vaccine is
safer than the previously used DTP.[13]
Another option for infants is DT which is a vaccine that is a combination of diphtheria and tetanus
vaccines. This is given as an alternative to infants who have conflicts with the DTaP vaccine.[9]
Quadrivalent, pentavalent, and hexavalent formulations contain DTaP with one or more of the additional
vaccines: inactivated poliovirus vaccine (IPV), Haemophilus influenzae type b conjugate, Hepatitis B,
with the availability varying in different countries.[14][15][16]

Schedule

Because DTaP and DT are administered to children less than a year old, the recommended location for
injection is the anterolateral thigh muscle. However, these vaccines can be injected into the deltoid
muscle if necessary.

The WHO recommends 6 doses in childhood starting at 6 weeks of age.[1] Four doses of DTaP are to be
given in early childhood.[9] The first dose should be around two months of age, the second at four
months age, the third at six months of age, and the fourth from fifteen months of age to eighteen months
of age. There is a recommended fifth dose to be administered to four- to six-year-olds.[9]

TD and TDaP are to be administered to older children, adolescents, and adults so it can therefore be
injected into the deltoid muscle.[9] These are boosters and are therefore to be administered at least every
ten years. And it is safe to have shorter intervals between a single dose of Tdap and a dose of the Td
booster.[17]

Additional doses

Booster shots are important because lymphocyte production (antibodies) is not at a constant high rate of
activity. This is because after the introduction of the vaccine when lymphocyte production is high, the
production activity of the white blood cells will start to decline. The decline in activity of the T-helper
cells means that there must be a booster to help keep the white blood cells active.[18]

Td and Tdap are the booster shots given every ten years to maintain immunity for adults nineteen years
of age to sixty-five years of age.[13]

Tdap is given as a onetime, first time only dose that includes the tetanus, diphtheria, and acellular
pertussis vaccinations.[13] This should not be administered to those who are under the age of eleven or
over the age of sixty-five.

Td is the booster shot given to people over the age of seven and includes the tetanus and diphtheria
toxoids. However, Td has less of the diphtheria which is why the "d" is lower case and the "T" is
capitalized.[13]
It is important to understand that booster shots should be administered before the age of sixty-five and
that one of these booster shots should be Tdap while the rest are Td.[9]

Side effects
As with any medications, there are side effects to these vaccines. The common side effects include
fever, redness, swelling around the injections, and soreness or tenderness around the injection site. There
are reported cases of body aches and tiredness following the Tdap. Td / Tdap can cause painful swelling
of the arm and reactions around the injections site,[9] (1 in 5 redness or swelling at the site of injection, 1
in 500 swelling of the entire arm)[19]

Mechanism of action
The type of vaccination for this disease is called artificial active immunity. This type of immunity is
generated when a dead or weakened version of the disease enters the body causing an immune response
which includes the production of antibodies. This is beneficial to the body because this means that if the
disease is ever introduced into the body, the immune system will recognize the antigen and produce
antibodies more rapidly.[20]

History
The first vaccine for passive immunology was discovered by a group of German scientists under the
leadership of Emil von Behring in 1890. The first inactive tetanus toxoid was discovered and produced
in 1924. A more effective adsorbed version of the vaccine, created in 1938, was proven to be successful
when it was used to prevent tetanus in the military during World War II.[9] DTP (which is the combined
vaccine for diphtheria, tetanus, and pertussis) was first used in 1948 and was continued until 1991 when
it was replaced with an acellular form of the pertussis vaccine because of safety concerns.[21] Half of
those who received the DTP vaccine had redness, swelling, and pain around the injection site[9] which
convinced researchers to find a replacement vaccine.

Two new vaccines were launched in 1992. These combined tetanus and diphtheria with acellular
pertussis (TDaP or DTaP) which could be given to adolescents and adults (as opposed to previously
when the vaccine was only given to children).[9]

References
1. "Tetanus vaccines: WHO position paper February 2017"
(http://apps.who.int/iris/bitstream/10665/254582/1/WER9206.pdf?ua=1) (PDF). Weekly
epidemiological record. 92 (6): 53/76. Nov 6, 2017.
2. Hamborsky, J (2015). "21". Pinkbook Tetanus Epidemiology of Vaccine Preventable Diseases
(https://www.cdc.gov/vaccines/pubs/pinkbook/tetanus.html) (13 ed.). CDC.
3. "Puncture wounds: First aid" (http://www.mayoclinic.org/first-aid/first-aid-puncture-
wounds/basics/art-20056665). Mayo Clinic. Feb 4, 2015. Retrieved 6 December 2015.
4. "Vaccines: VPD-VAC/Tetanus/main page" (http://www.cdc.gov/vaccines/vpd-
vac/tetanus/default.htm). Centers for Disease Control. Retrieved February 10, 2015.
5. Macera, Caroline (2012). Introduction to Epidemiology: Distribution and Determinants of
Disease (https://books.google.ca/books?id=U8FuCgAAQBAJ&pg=PA251). Nelson Education.
p. 251. ISBN 9781285687148.
6. "WHO Model List of Essential Medicines (19th List)"
(http://www.who.int/medicines/publications/essentialmedicines/EML_2015_FINAL_amended_NOV2015.pdf
ua=1) (PDF). World Health Organization. April 2015. Retrieved 8 December 2016.
7. "Vaccine, Tetanus Toxoid" (http://erc.msh.org/dmpguide/resultsdetail.cfm?
language=english&code=TT00X&s_year=2014&year=2014&str=&desc=Vaccine%2C%20Tetanus%20Toxoi
International Drug Price Indicator Guide. Retrieved 6 December 2015.
8. Hamilton, Richart (2015). Tarascon Pocket Pharmacopoeia 2015 Deluxe Lab-Coat Edition. Jones
& Bartlett Learning. p. 317. ISBN 9781284057560.
9. Centers for Disease Control and Preventi (2011). "Tetanus". Epidemiology and Prevention of
Vaccine-Preventable Diseases (CDC, Epidemiology and Prevention of Vaccine-Preventable
Diseases (http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/tetanus.pdf) (pdf). Washington,
D.C: Public Health Foundation. ISBN 0-01-706609-3. Retrieved January 4, 2016.
10. http://www.cdc.gov/tetanus/about/index.html
11. Health Care Guideline: Routine Prenatal Care. Fourteenth Edition.
(http://www.icsi.org/prenatal_care_4/prenatal_care__routine__full_version__2.html) By the
Institute for Clinical Systems Improvement. July 2010.
12. Updated Recommendations for Use of Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular
Pertussis Vaccine (Tdap) in Pregnant Women and Persons Who Have or Anticipate Having Close
Contact with an Infant Aged <12 Months, 2011
(http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6041a4.htm?s_cid=mm6041a4_e%0d%0a) -
section "Safety of Tdap in Pregnant Women". By the Advisory Committee on Immunization
Practices (ACIP), at Centers for Disease Control and Prevention.
13. "Vaccines: VPD-VAC/Tetanus/main page" (http://www.cdc.gov/vaccines/vpd-
vac/tetanus/default.htm). Centers for Disease Control. Retrieved 2012-06-04.
14. "2016 Binational Immunization Resource Tool for Children from Birth Through 18 Years"
(https://www.cdc.gov/vaccines/schedules/downloads/child/binational-schedule-pr.pdf) (PDF).
Centers for Disease Control. Retrieved 2016-12-22.
15. "Licensure of a Diphtheria and Tetanus Toxoids and Acellular Pertussis Adsorbed, Inactivated
Poliovirus, and Haemophilus b Conjugate Vaccine and Guidance for Use in Infants and Children"
(https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5739a5.htm). Centers for Disease Control.
Retrieved 2016-12-22.
16. Baldo V, Bonanni P, Castro M, Gabutti G, Franco E, Marchetti F, Prato R, Vitale F. "Combined
hexavalent diphtheria-tetanus-acellular pertussis-hepatitis B-inactivated poliovirus-Haemophilus
influenzae type B vaccine; Infanrix hexa: twelve years of experience in Italy"
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4181021). Hum Vaccin Immunother. 10 (1): 129
37. PMC 4181021 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4181021) .
PMID 24004825 (https://www.ncbi.nlm.nih.gov/pubmed/24004825). doi:10.4161/hv.26269
(https://doi.org/10.4161%2Fhv.26269).
17. Talbot, Elizabeth A (2010). The Safety of Immunizing with Tetanusdiphtheriaacellular
Pertussis Vaccine (Tdap) Less than 2 Years following Previous Tetanus Vaccination: Experience
during a Mass Vaccination Campaign of Healthcare Personnel during a Respiratory Illness
Outbreak. pp. 80018007.
18. Veronesi, R (1981). Tetanus: Important New Concepts. Amsterdam: Excerpta Medica.
19. "Vaccine Information Statement | Tdap | Tetanus-Diphtheria-Pertussis | VIS | CDC"
(http://www.cdc.gov/vaccines/hcp/vis/vis-statements/tdap.html). www.cdc.gov. Retrieved
9 December 2016.
20. "Vaccines & Immunizations" (http://www.cdc.gov/vaccines/vac-gen/immunity-types.htm).
Retrieved 27 Nov 2011.
21. "Whooping Cough: Vaccine Combined with Tetanus, Diphtheria"
(https://www.historyofvaccines.org/timeline#EVT_100746). Retrieved May 1, 2017.

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This page was last edited on 3 August 2017, at 02:10.


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