Tetanus vaccine is familiar to all. The vaccine is given to prevent disease that occurs when Clostridia tetani spores enter a wound. However, there is a new vaccine recommended to be used that changes the routine, although only slightly. Most all adults received a primary vaccination of three tetanus shots as an infant. The routine recommendation has been a tetanus diptheria (Td) booster about every 10 years or when it came to mind after incurring a wound. Adacel (Sanofi Pasteur, licensed 2005) contains tetanus toxoid and diptheria toxoid, but also contains detoxified pertussis toxin. It is the first vaccine licensed for adults and adolescents that protects against all three diseases. It is also called Tdap vaccine. Boostrix (GlaxoSmithKline Biologicals) is a second Tdap vaccine that was FDA approved for adults in 2008.
These two very similar vaccines are approved for adults up to age 64. By widespread use of Tdap, it is expected that immunity will be increased to pertussis and many cases of that infection avoided. Please see pertussis section that follows. Who should get Tdap? Adults age less than 65 who incur a wound for which a tetanus vaccine would normally be given should receive a one time booster dose of Tdap if they have not received one previously. Future tetanus boosters, if given, should be Td as has been done in the past. Also, for preventive health purposes, adults age less than 65 should receive a dose of Tdap instead of the usual Td.
Who should not get Tdap? At the present time, the 2 Tdap vaccines are not licensed for use in adults age 65 or older. Td should be used if tetanus booster is needed in this age group. Safety has not been established for pregnant women, so Td should be used if pregnant. Tdap can be safely given immediately after delivery. Patients with allergic reactions to Td or other tetanus - containing vaccines (DTP,DTaP, or DT) should not get Tdap.
Pain and or redness at the injection site occasionally occurs. Fever is a less common problem. It can be safely given with other vaccines, including influenza.
In summary, the long standing recommendation of a tetanus booster (Td) about every 10 years remains in effect, but over a life time one of these boosters should be Tdap.