Tetanus vaccine

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Tetanus vaccine
DPT-IPV-japan Quattro back.jpg
Tetanus vaccination is often administered via combination DPT vaccines
Vaccine description
Target Tetanus
Vaccine type Toxoid
Clinical data
MedlinePlus a682198
License data
Routes of
administration 		injection
ATC code
Legal status
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Tetanus vaccine, also known as tetanus toxoid (TT), is a toxoid vaccine used to prevent tetanus. [2] During childhood, five doses are recommended, with a sixth given during adolescence. [2]

Contents

After three doses, almost everyone is initially immune, [2] but additional doses every ten years are recommended to maintain immunity. [3] A booster shot should be given within 48 hours of an injury to people whose immunization is out of date. [4]

Confirming that pregnant women are up to date on tetanus immunization during each pregnancy can prevent both maternal and neonatal tetanus. [2] [5] [6] The vaccine is very safe, including during pregnancy and in those with HIV/AIDS. [2]

Redness and pain at the site of injection occur in between 25% and 85% of people. [2] Fever, feeling tired, and minor muscle pain occurs in less than 10% of people. [2] Severe allergic reactions occur in fewer than one in 100,000 people. [2]

A number of vaccine combinations include the tetanus vaccine, such as DTaP and Tdap, which contain diphtheria, tetanus, and pertussis vaccines, and DT and Td, which contain diphtheria and tetanus vaccines. [7] 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. [7] [8] The lowercase d and p denote lower strengths of diphtheria and pertussis vaccines. [7]

Tetanus antiserum was developed in 1890, with its protective effects lasting a few weeks. [9] [10] The tetanus toxoid vaccine was developed in 1924, and came into common use for soldiers in World War II. [2] [11] Its use resulted in a 95% decrease in the rate of tetanus. [2] It is on the World Health Organization's List of Essential Medicines. [12] [13]

Medical uses

Effectiveness

Decrease in tetanus deaths by age group between 1990 and 2017 Tetanus-deaths-by-age-group.png
Decrease in tetanus deaths by age group between 1990 and 2017

Vaccination confers near-complete protection from tetanus, provided the individual has received their recommended booster shots. [15] Globally, deaths from tetanus in newborns decreased from 787,000 in 1988 to 58,000 in 2010, and 34,000 deaths in 2015 (a 96% decrease from 1988). [3] [16] In the 1940s, before the vaccine, there were about 550 cases of tetanus per year in the United States, which has decreased to about 30 cases per year in the 2000s. [3] Nearly all cases are among those who have never received a vaccine, or adults who have not stayed up to date on their 10-year booster shots. [17]

Pregnancy

Guidelines on prenatal care in the United States specify that women should receive a dose of the Tdap vaccine during each pregnancy, preferably between weeks 27 and 36, to allow antibody transfer to the fetus. [5] [6] All postpartum women who have not previously received the Tdap vaccine are recommended to get it prior to discharge after delivery. [18] It is recommended for pregnant women who have never received the tetanus vaccine (i.e., neither DTP or DTaP, nor DT as a child or Td or TT as an adult) to receive a series of three Td vaccinations starting during pregnancy to ensure protection against maternal and neonatal tetanus. In such cases, Tdap is recommended to be substituted for one dose of Td, again preferably between 27 and 36 weeks of gestation, and then the series completed with Td. [5] [6]

Specific types

The first vaccine is given in infancy. The baby is injected with the DTaP vaccine, which is three inactive toxins in one injection. DTaP protects against diphtheria, pertussis, and tetanus. This acellular vaccine is safer than the previously used DTP with whole inactivated pertussis (now retroactively notated DTwP [19] ). [7] Another option is DT, which is a combination of diphtheria and tetanus vaccines. This is given as an alternative to infants who have conflicts with the DTaP vaccine. [15] Quadrivalent, pentavalent, and hexavalent formulations contain DTaP with one or more of the additional vaccines: inactivated polio virus vaccine (IPV), Haemophilus influenzae type b conjugate, Hepatitis B, with the availability varying in different countries. [20] [21] [22]

For the every ten-year booster Td or Tdap may be used, though Tdap is more expensive. [6]

Schedule

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

The World Health Organization (WHO) recommends six doses in childhood starting at six weeks of age. [2] Four doses of DTaP are to be given in early childhood. [15] The first dose should be around two months of age, the second at four months, the third at six, and the fourth from fifteen to eighteen months of age. There is a recommended fifth dose to be administered to four- to six-year-olds. [15]

Td and Tdap are for older children, adolescents, and adults and can be injected into the deltoid muscle. [15] These are boosters and are recommended every ten years. It is safe to have shorter intervals between a single dose of Tdap and a dose of the Td booster. [23]

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 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. [24]

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. [6]

Tdap is given as a one-time, first-time-only dose that includes the tetanus, diphtheria, and acellular pertussis vaccinations. [7] This should not be administered to those who are under the age of eleven or over the age of sixty-five.[ medical citation needed ]

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 toxoid, which is why the "d" is lowercase and the "T" is capitalized. [7]

In 2020, the US Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) recommended that either tetanus and diphtheria toxoids (Td) vaccine or Tdap to be used for the decennial Td booster, tetanus prevention during wound management, and for additional required doses in the catch-up immunization schedule if a person has received at least one Tdap dose. [6]

Side effects

A bump resulting from a tetanus vaccine injection Tetanusimpfung - Tag danach Crop.jpg
A bump resulting from a tetanus vaccine injection

Common side effects of the tetanus vaccine include fever, redness, and swelling with soreness or tenderness around the injection site (one in five people have redness or swelling). Body aches and tiredness have been reported following Tdap. Td / Tdap can cause painful swelling of the entire arm in one of 500 people. [15] [25] Tetanus toxoid containing vaccines (DTaP, DTP, Tdap, Td, DT) may cause brachial neuritis at a rate of one out of every 100,000 to 200,000 doses. [3] [26]

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 because it means that if the disease is ever introduced into the body, the immune system will recognize the antigen and produce antibodies more rapidly. [27]

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. [15] DTP/DTwP (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 due to safety concerns. [28] Half of those who received the DT(w)P vaccine had redness, swelling, and pain around the injection site, [15] 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). [15]

Related Research Articles

<span class="mw-page-title-main">Exotoxin</span> Toxin from bacteria that destroys or disrupts cells

An exotoxin is a toxin secreted by bacteria. An exotoxin can cause damage to the host by destroying cells or disrupting normal cellular metabolism. They are highly potent and can cause major damage to the host. Exotoxins may be secreted, or, similar to endotoxins, may be released during lysis of the cell. Gram negative pathogens may secrete outer membrane vesicles containing lipopolysaccharide endotoxin and some virulence proteins in the bounding membrane along with some other toxins as intra-vesicular contents, thus adding a previously unforeseen dimension to the well-known eukaryote process of membrane vesicle trafficking, which is quite active at the host–pathogen interface.

<span class="mw-page-title-main">DPT vaccine</span> Combination vaccine

The DPT vaccine or DTP vaccine is a class of combination vaccines against three infectious diseases in humans: diphtheria, pertussis, and tetanus. The vaccine components include diphtheria and tetanus toxoids and either killed whole cells of the bacterium that causes pertussis or pertussis antigens. The term toxoid refers to vaccines which use an inactivated toxin produced by the pathogen which they are targeted against to generate an immune response. In this way, the toxoid vaccine generates an immune response which is targeted against the toxin which is produced by the pathogen and causes disease, rather than a vaccine which is targeted against the pathogen itself. The whole cells or antigens will be depicted as either "DTwP" or "DTaP", where the lower-case "w" indicates whole-cell inactivated pertussis and the lower-case "a" stands for "acellular". In comparison to alternative vaccine types, such as live attenuated vaccines, the DTP vaccine does not contain any live pathogen, but rather uses inactivated toxoid to generate an immune response; therefore, there is not a risk of use in populations that are immune compromised since there is not any known risk of causing the disease itself. As a result, the DTP vaccine is considered a safe vaccine to use in anyone and it generates a much more targeted immune response specific for the pathogen of interest.

<span class="mw-page-title-main">Vaccination schedule</span> Series of vaccinations

A vaccination schedule is a series of vaccinations, including the timing of all doses, which may be either recommended or compulsory, depending on the country of residence. A vaccine is an antigenic preparation used to produce active immunity to a disease, in order to prevent or reduce the effects of infection by any natural or "wild" pathogen. Vaccines go through multiple phases of trials to ensure safety and effectiveness.

In immunology, the Arthus reaction is a type of local type III hypersensitivity reaction. Type III hypersensitivity reactions are immune complex-mediated, and involve the deposition of antigen/antibody complexes mainly in the vascular walls, serosa, and glomeruli. This reaction is usually encountered in experimental settings following the injection of antigens.

<span class="mw-page-title-main">Booster dose</span> Additional administration of vaccine

A booster dose is an extra administration of a vaccine after an earlier (primer) dose. After initial immunization, a booster provides a re-exposure to the immunizing antigen. It is intended to increase immunity against that antigen back to protective levels after memory against that antigen has declined through time. For example, tetanus shot boosters are often recommended every 10 years, by which point memory cells specific against tetanus lose their function or undergo apoptosis.

Immunization during pregnancy is the administration of a vaccine to a pregnant individual. This may be done either to protect the individual from disease or to induce an antibody response, such that the antibodies cross the placenta and provide passive immunity to the infant after birth. In many countries, including the US, Canada, UK, Australia and New Zealand, vaccination against influenza, COVID-19 and whooping cough is routinely offered during pregnancy.

<span class="mw-page-title-main">Hepatitis B vaccine</span> Vaccine against hepatitis B

Hepatitis B vaccine is a vaccine that prevents hepatitis B. The first dose is recommended within 24 hours of birth with either two or three more doses given after that. This includes those with poor immune function such as from HIV/AIDS and those born premature. It is also recommended that health-care workers be vaccinated. In healthy people, routine immunization results in more than 95% of people being protected.

<span class="mw-page-title-main">Hib vaccine</span> Haemophilus influenzae type B vaccine

The Haemophilus influenzae type B vaccine, also known as Hib vaccine, is a vaccine used to prevent Haemophilus influenzae type b (Hib) infection. In countries that include it as a routine vaccine, rates of severe Hib infections have decreased more than 90%. It has therefore resulted in a decrease in the rate of meningitis, pneumonia, and epiglottitis.

<span class="mw-page-title-main">Diphtheria vaccine</span> Vaccine against diphtheria

Diphtheria vaccine is a toxoid vaccine against diphtheria, an illness caused by Corynebacterium diphtheriae. Its use has resulted in a more than 90% decrease in number of cases globally between 1980 and 2000. The first dose is recommended at six weeks of age with two additional doses four weeks apart, after which it is about 95% effective during childhood. Three further doses are recommended during childhood. It is unclear if further doses later in life are needed.

<span class="mw-page-title-main">Pertussis vaccine</span> Vaccine protecting against whooping cough

Pertussis vaccine is a vaccine that protects against whooping cough (pertussis). There are two main types: whole-cell vaccines and acellular vaccines. The whole-cell vaccine is about 78% effective while the acellular vaccine is 71–85% effective. The effectiveness of the vaccines appears to decrease by between 2 and 10% per year after vaccination with a more rapid decrease with the acellular vaccines. The vaccine is only available in combination with tetanus and diphtheria vaccines. Pertussis vaccine is estimated to have saved over 500,000 lives in 2002.

Meningococcal vaccine refers to any vaccine used to prevent infection by Neisseria meningitidis. Different versions are effective against some or all of the following types of meningococcus: A, B, C, W-135, and Y. The vaccines are between 85 and 100% effective for at least two years. They result in a decrease in meningitis and sepsis among populations where they are widely used. They are given either by injection into a muscle or just under the skin.

<span class="mw-page-title-main">Cocooning (immunization)</span> Vaccination strategy

Cocooning, also known as the Cocoon Strategy, is a vaccination strategy to protect infants and other vulnerable individuals from infectious diseases by vaccinating those in close contact with them. If the people most likely to transmit an infection are immune, their immunity creates a "cocoon" of protection around the newborn.

A Vaccine Information Statement (VIS) is a document designed by the Centers for Disease Control and Prevention (CDC) to provide information to a patient receiving a vaccine in the United States. The National Childhood Vaccine Injury Act requires that medical professionals provide a VIS to patients before receiving certain vaccinations. The VIS includes information about the vaccine's benefits and risks, a description of the vaccine, indications and contraindications, instructions for patients experiencing an adverse reaction, and additional resources.

<span class="mw-page-title-main">DTaP-IPV vaccine</span> Vaccine against diphtheria, tetanus, whooping cough and polio

DTaP-IPV vaccine is a combination vaccine whose full generic name is diphtheria and tetanus toxoids and acellular pertussis adsorbed and inactivated poliovirus vaccine (IPV).

DTaP-IPV/Hib vaccine is a 5-in-1 combination vaccine that protects against diphtheria, tetanus, whooping cough, polio, and Haemophilus influenzae type B.

DTaP-IPV-HepB vaccine is a combination vaccine whose generic name is diphtheria and tetanus toxoids and acellular pertussis adsorbed, hepatitis B (recombinant) and inactivated polio vaccine or DTaP-IPV-Hep B. It protects against the infectious diseases diphtheria, tetanus, pertussis, poliomyelitis, and hepatitis B.

DPT-Hib vaccine is a combination vaccine whose generic name is diphtheria and tetanus toxoids and whole-cell pertussis vaccine adsorbed with Hib conjugate vaccine, sometimes abbreviated to DPT-Hib. It protects against the infectious diseases diphtheria, tetanus, pertussis, and Haemophilus influenzae type B.

DTaP-Hib vaccine is a combination vaccine whose generic name is diphtheria and tetanus toxoids and acellular pertussis adsorbed with Haemophilus B conjugate vaccine, sometimes abbreviated to DTaP-Hib. It protects against the infectious diseases diphtheria, tetanus, pertussis, and Haemophilus influenzae type B.

<span class="mw-page-title-main">Hexavalent vaccine</span> Single vaccine protecting against six individual diseases

A hexavalent vaccine, or 6-in-1 vaccine, is a combination vaccine with six individual vaccines conjugated into one, intended to protect people from multiple diseases. The term usually refers to the children's vaccine that protects against diphtheria, tetanus, pertussis, poliomyelitis, haemophilus B, and hepatitis B, which is used in more than 90 countries around the world including in Europe, Canada, Australia, Jordan, and New Zealand.

Trudy Virginia Noller Murphy is an American pediatric infectious diseases physician, public health epidemiologist and vaccinologist. During the 1980s and 1990s, she conducted research at Southwestern Medical School in Dallas, Texas on three bacterial pathogens: Haemophilus influenzae type b (Hib), Streptococcus pneumoniae (pneumococcus), and methicillin-resistant Staphylococcus aureus (MRSA). Murphy's studies advanced understanding of how these organisms spread within communities, particularly among children attending day care centers. Her seminal work on Hib vaccines elucidated the effects of introduction of new Hib vaccines on both bacterial carriage and control of invasive Hib disease. Murphy subsequently joined the National Immunization Program at the Centers for Disease Control and Prevention (CDC) where she led multi-disciplinary teams in the Divisions of Epidemiology and Surveillance and The Viral Hepatitis Division. Among her most influential work at CDC was on Rotashield™, which was a newly licensed vaccine designed to prevent severe diarrheal disease caused by rotavirus. Murphy and her colleagues uncovered that the vaccine increased the risk of acute bowel obstruction (intussusception). This finding prompted suspension of the national recommendation to vaccinate children with Rotashield, and led the manufacturer to withdraw the vaccine from the market. For this work Murphy received the United States Department of Health and Human Services Secretary's Award for Distinguished Service in 2000, and the publication describing this work was recognized in 2002 by the Charles C. Shepard Science Award from the Centers for Disease Control and Prevention.

References

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  2. 1 2 3 4 5 6 7 8 9 10 11 World Health Organization (February 2017). "Tetanus vaccines: WHO position paper – February 2017" (PDF). Weekly Epidemiological Record. 92 (6): 53–76. hdl: 10665/254583 . PMID   28185446.
  3. 1 2 3 4 Hamborsky J, Kroger A, Wolfe S, eds. (2015). "Chapter 21: Tetanus". Epidemiology and Prevention of Vaccine-Preventable Diseases (13th ed.). Centers for Disease Control and Prevention (CDC). Archived from the original on 13 April 2017.PD-icon.svg This article incorporates text from this source, which is in the public domain .
  4. ↑ "Puncture wounds: First aid". Mayo Clinic. 4 February 2015. Archived from the original on 8 December 2015. Retrieved 6 December 2015.
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  13. ↑ World Health Organization (2021). World Health Organization model list of essential medicines: 22nd list (2021). Geneva: World Health Organization. hdl: 10665/345533 . WHO/MHP/HPS/EML/2021.02.
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  15. 1 2 3 4 5 6 7 8 9 Centers for Disease Control and Prevention (2011). "Tetanus". Epidemiology and Prevention of Vaccine-Preventable Diseases (CDC, Epidemiology and Prevention of Vaccine-Preventable Diseases) (PDF). Washington, D.C: Public Health Foundation. ISBN   978-0-01-706609-1. Archived (PDF) from the original on 6 March 2008. Retrieved 4 January 2016.PD-icon.svg This article incorporates text from this source, which is in the public domain .
  16. ↑ World Health Organization (9 May 2018). "Tetanus". World Health Organization (WHO). Retrieved 12 January 2020.
  17. ↑ "About Tetanus". Centers for Disease Control and Prevention (CDC). Archived from the original on 11 November 2014. Retrieved 11 December 2014.PD-icon.svg This article incorporates text from this source, which is in the public domain .
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  19. ↑ Syed MA (February 2017). "Choosing from Whole Cell and Acellular Pertussis Vaccines-Dilemma for the Developing Countries". Iranian Journal of Public Health. 46 (2): 272–273. PMC   5402791 . PMID   28451568.
  20. ↑ "2016 Binational Immunization Resource Tool for Children from Birth Through 18 Years" (PDF). Centers for Disease Control and Prevention (CDC). Archived (PDF) from the original on 11 February 2017. Retrieved 22 December 2016.PD-icon.svg This article incorporates text from this source, which is in the public domain .
  21. ↑ Centers for Disease Control Prevention (CDC) (October 2008). "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". MMWR Morb. Mortal. Wkly. Rep. 57 (39): 1079–80. PMID   18830213. Archived from the original on 7 November 2016. Retrieved 22 December 2016.PD-icon.svg This article incorporates text from this source, which is in the public domain .
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  24. ↑ Veronesi R (1981). Tetanus: Important New Concepts. Amsterdam: Excerpta Medica.
  25. ↑ "Tdap (Tetanus, Diphtheria, Pertussis) Vaccine Information Statement". U.S. Centers for Disease Control and Prevention (CDC). August 2021. Archived from the original on 28 December 2019. Retrieved 28 December 2019.PD-icon.svg This article incorporates text from this source, which is in the public domain .
  26. ↑ "Update: vaccine side effects, adverse reactions, contraindications, and precautions. Recommendations of the Advisory Committee on Immunization Practices (ACIP)" (PDF). MMWR Recomm Rep. 45 (RR-12): 1–35. September 1996. PMID   8801442.PD-icon.svg This article incorporates text from this source, which is in the public domain .
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  28. ↑ "Whooping Cough: Vaccine Combined with Tetanus, Diphtheria". Archived from the original on 6 June 2017. Retrieved 1 May 2017.

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