This vaccine is indicated for the prevention of tetanus in children aged 7 years and above, as well as in adults, particularly those at higher risk of exposure such as gardeners, agricultural workers, and athletes. It is also used for preventing neonatal tetanus through immunization of women of childbearing age and for prophylaxis following injuries. The vaccine can be administered safely and effectively at the same time as BCG, measles, polio (IPV and OPV), hepatitis B, yellow fever, Haemophilus influenzae type B, and varicella vaccines.

HIV Infection: Adsorbed tetanus vaccine may be administered to children with known or suspected HIV infection. Although data are limited, current evidence does not show an increased risk of adverse reactions in either symptomatic or asymptomatic HIV-infected children.

Adsorbed tetanus toxoid BP is prepared by detoxifying sterile filtrates of Clostridium tetani cultures using formalin and heat. The toxoid is then purified chemically and adsorbed onto aluminium phosphate, which acts as an adjuvant. Thiomersal is included as a preservative. The vaccine appears as a greyish-white suspension and does not contain horse serum protein, thus avoiding sensitization to equine proteins. It complies with WHO standards as specified in WHO Technical Report Series (TRS 800, 1990).

The full basic course of immunization against tetanus consists of two primary doses of 0.5 ml at least four weeks apart, followed by the third dose 6-12 months later. To maintain a high level of immunity further 0.5 ml. booster doses are recommended at every feasible interval (for adults usually 5 to 10 years).

Protection of the Newborn against Tetanus: For prevention of neonatal tetanus, Tetanus Toxoid vaccine is recommended for immunization of women of childbearing age, and especially pregnant women. Tetanus Toxoid vaccine may be safely administered during pregnancy and should be given to the mother at first contact or as early as possible in pregnancy. A five dose schedule is recommended for previously unimmunized women of childbearing age: after the basic course of immunization with three doses, two additional booster doses should be given, at least one year after the previous dose or during the subsequent pregnancy.

Vaccination of Injured Person: For those subjects who have proof of either completing their course of primary immunizations containing tetanus toxoid or receiving a booster shot within the previous 5 years no additional dose of tetanus toxoid is recommended. If more than 5 years have elapsed, and infection with tetanus because of injury or other cause is suspected, 0.5ml of the Tetanus Toxoid vaccine should be given immediately. Where the immunization history is inadequate 1500 IU (3000 old AU) tetanus antiserum and 0.5 ml Tetanus Toxoid vaccine should be injected, with separate syringes, to different body sites. (If available, 250 units of tetanus immune globulin (human origin) can be substituted for the tetanus antiserum). A second 0.5ml dose of Tetanus Toxoid vaccine is recommended after 2 weeks and a third dose after a further 1 month.

A note of caution: if horse-origin tetanus antiserum is used in prophylaxis, the patient should be tested for sensitivity to horse serum protein prior to its administration. It is desirable to have 1 ml of Adrenaline solution (1:1000) immediately available and the normal precautions followed when injecting antitoxins.

Method of Inoculation: This should be injected intramuscularly into the deltoid muscle in women and older children. Only sterile needles and syringes should be used for each injection. The vaccine should be well shaken before use. Once opened, multi-dose vials should be kept between 2°C to 8°C.

Reactions: Reactions are generally mild and confined to the site of injection. Some inflammation may occur together with transient fever, malaise and irritability. Occasionally a nodule may develop at the site of injection but this is rare. An increased severity of reactions to vaccination may be observed in subjects. Who have had many booster immunizations.

If passive immunization against tetanus is required, human tetanus immune globulin (TIG) is preferred. It provides longer protection compared to animal-derived antitoxin and is associated with fewer adverse reactions. As with other intramuscular injections, caution should be exercised in patients receiving anticoagulant therapy. Immunosuppressive treatments may reduce the effectiveness of vaccines by diminishing the immune response.

This vaccine should not be administered to individuals who have experienced a severe hypersensitivity reaction to a previous dose of tetanus toxoid. Vaccination should be postponed in individuals with febrile illness or acute infection. However, mild illnesses such as minor upper respiratory tract infections do not contraindicate immunization.

Adsorbed tetanus vaccine is generally well tolerated. Most reactions are mild to moderate and of short duration. Commonly, local reactions occur at the injection site, including redness (erythema), swelling (induration), and tenderness. Systemic reactions such as malaise and fever are less frequently reported.

For prevention of neonatal tetanus, tetanus toxoid is recommended for women of childbearing age, particularly during pregnancy. It can be safely administered during pregnancy and should ideally be given at the earliest opportunity. It is not known whether tetanus toxoid is excreted in human milk. It may be given to breastfeeding mothers only when clearly indicated.

For management of severe anaphylaxis, adrenaline is the primary treatment. The initial adult dose is 0.1–0.5 mg (0.1–0.5 mL of 1:1000 solution) administered subcutaneously or intramuscularly, not exceeding 1 mg per dose. In children, the recommended dose is 0.01 mg/kg (0.01 mL/kg of 1:1000 solution), with a maximum of 0.5 mg per dose. Early administration of adrenaline is critical and can be life-saving.

After vaccination, individuals should be observed for at least 30 minutes for any immediate allergic reactions. Emergency medications such as hydrocortisone sodium succinate and antihistamines, along with supportive measures like oxygen, should be readily available.

There is an increased likelihood of local and systemic reactions following booster doses in previously immunized individuals. Care should be taken to avoid intravascular injection. It is important to inquire about any adverse reactions following previous doses when patients return for subsequent vaccinations.

Vaccines, Antisera & Immunoglobulins

Keep out of reach and sight of children. Store at 2°C to 8°C. Maintain the same temperature during transportation. Do not freeze. Discard if frozen. Protect from light.