Anti-Tetanus Vaccination

Availability

1. Adsorbed Tetanus Toxoid Vaccine (10 doses of 0.5ml doses/ vial)

• indicated for booster injection only for persons against tetanus (tetanus toxoid) 
• This vaccine is NOT indicated for primary immunization.
• Prevention of neonatal tetanus by immunizing women of childbearing age

2. Human Anti-Tetanus Immunoglobin

• Prophylaxis in persons with recent injury that might be contaminated and did not receive vaccines in the previous 10 years
• adults and children 7 years of age and older : 250 units by deep intramuscular injection. 
• small children less than 7 years old: 4 units/kg. However, it may be advisable to administer 250 units regardless of the child’s size, since theoretically the same amount of toxin will be produced in the child’s body by the infecting tetanus organism as it will in an adult’s body
• Treatment of clinically manifested tetanus
• When used in the treatment of tetanus, TIg should be administered intramuscularly in an effort to neutralize tetanus toxin in body fluids. It has no effect on toxin already fixed to nerve tissue. 
• The optimal therapeutic dose has not been established
• Our product recommends 3000-6000 units IM

Age Limit

• Based on Guides, Tetanus Toxoid vaccines are intended for children abovethe age of 7 years
• (below 7 years should receive 5 doses of DTaP as per the schedule)
• Based on the representative from the company, there is no age limit for the vaccine (2 months as per immunisation schedule/ DTaP)

Pregnancy

• Category C
• Adequate immunization by routine boosters in non-pregnant women of child-bearing age can obviate the need to vaccinate women during pregnancy 
• Animal reproduction studies have not been conducted with Tetanus Toxoid. 
• risk to the fetus from tetanus toxoid is unknown. 
• The ACIP recommends that an appropriate tetanus toxoid-containing preparation be given to inadequately immunized pregnant women because it affords protection against neonatal tetanus.
•  Waiting until the second trimester is a reasonable precaution to minimize any theoretical teratogenic concern.

Tetanus Prone Wounds

• wounds or burns that need surgery, but where surgery cannot be performed within 24 hours 
• wounds or burns where a significant amount of tissue has been removed, or puncture-type injuries (such as animal bites), particularly if they have had contact with soil or manure
• wounds containing foreign bodies (any substance that shouldn’t be there, such as dust or dirt)
• compound fractures (serious fractures where the bone is exposed and prone to infection)
• wounds and burns in people who have systemic sepsis (a fall in blood pressure resulting from a serious bacterial infection)

Post Exposure Prophylaxis

• Effective neutralizing antibody concentrations at the time of the injury can only be achieved by prior completion of the tetanus toxoid-containing vaccine series or immediate administration of tetanus immune globulin (TIg).

REFERENCE:

1. http://www.nhs.uk/chq/pages/1316.aspx?categoryid=67&subcategoryid=150
2. http://www.who.int/features/qa/04/en/
3. http://www.phac-aspc.gc.ca/publicat/cig-gci/p04-tet-eng.php
4. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6001a4.htm
5. http://www.rxlist.com/tetanus-drug/warnings-precautions.htm
6. http://wwwnc.cdc.gov/travel/yellowbook/2016/the-pre-travel-consultation/general-recommendations-for-vaccination-immunoprophylaxis