Vaccines: Diphtheria and Tetanus

Specific vaccination recommendations vary among countries or even within a given country. Local or country-specific guidelines should be consulted.

1. Vaccines: Various diphtheria and tetanus vaccines are available. Tetanus and diphtheria vaccine for adults (abbreviated as Td in Canada) contains diphtheria toxoid (inactivated toxin) in a reduced dose and tetanus toxoid. These are inactivated vaccines that should be administered IM. There are also a variety of vaccines combining diphtheria and tetanus with other vaccines such as acellular pertussis, inactivated polio, hepatitis B, and Haemophilus influenzae type b (these combination vaccines are abbreviated based on their components, eg, TdaP-IPV includes tetanus, diphtheria, acellular pertussis, and inactivated polio vaccines).

2. Indications: Diphtheria and tetanus booster doses every 10 years are recommended in adults who have received a complete primary vaccination series in the past. Adults with unknown vaccination status and those who have not completed a primary vaccination series should undergo a 3-dose vaccination series followed by booster doses every 10 years.

Serologic testing is not routinely recommended to confirm immunity to diphtheria or tetanus.

3. Contraindications include general contraindications for all inactivated vaccines (eg, allergy to vaccine components or a past anaphylactic reaction). Vaccination should be postponed in patients with acute illness. Patients who have a severe injection-site reaction (Arthus-type reaction: type III hypersensitivity reactions of local vasculitis associated with deposition of immune complexes and activation of complement) should not be vaccinated again for 10 years. Further vaccination with diphtheria or tetanus vaccines should be avoided in patients who develop Guillain-Barré syndrome within 6 weeks of vaccination.

4. Diphtheria postexposure prophylaxis with a dose of diphtheria toxoid–containing vaccine is recommended for close contacts of patients with diphtheria unless they have been fully vaccinated and the most recent dose of vaccine has been administered within 10 years. Close contacts should also have cultures performed for carriage of Corynebacterium diphtheriae and be treated empirically with penicillin or erythromycin.

5. Tetanus postexposure prophylaxis in the case of injuries associated with a risk of tetanus infection is based on the type of wound, number of previous vaccinations, and time since the most recent vaccine dose (Table 1). If both vaccine and immunoglobulin are required, they should be administered using different needles at different anatomic sites. Thorough wound cleaning and debridement of necrotic tissue is also important in preventing tetanus.

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