• Tetanus is an acute disease caused by the action of tetanus toxin, released following infection by the bacterium Clostridium tetani. Tetanus spores are present in soil or manure and may be introduced into the body through a puncture wound, burn or scratch.
• The symptoms of tetanus are characterized by generalized rigidity and spasms of skeletal muscles. The case fatality ratio ranges from 10 to 90%.

• All people should receive tetanus vaccine as part of the childhood vaccination programme.
• For travellers give a booster dose of tetanus/diphtheria/inactivated polio vaccine (Td/IPV), before departure, to:
• Anyone travelling to areas where medical attention may not be accessible and whose last dose of a tetanus-containing vaccine was more than 10 years previously even if the person has received five doses of vaccine previously (3 primary immunization doses and 2 booster doses).
• Anyone travelling to areas where medical attention may not be accessible and whose last dose of a tetanus-containing vaccine was more than 10 years previously and has received a tetanus primary immunization (3 doses) course but, none or one of the recommended booster doses.
• For travellers who have not received a tetanus primary immunization course (3 doses) it is usually worth giving the maximum number of doses of vaccines that the travel departure date allows and completing the course upon return.

In depth

• Tetanus vaccine is available as an inactivated vaccine and is only available as part of a combined product:
• Infanrix-IPV-Hib^®, Pediacel^® (DTaP/IPV/Hib)
• Infanrix-IPV^® (DTaP/IPV or dTaP/IPV)
• Repevax^® (dTaP/IPV)
• Revaxis^® (Td/IPV)

In depth

• Vaccinate all children under 10 years of age who have not been vaccinated according to the childhood vaccination programme (see the CKS topic on Immunizations - childhood).
• For children aged over 10 years and adults who have not been vaccinated give:
• A primary course: three doses of vaccine (as Td/IPV) 1 month apart.
• Two booster doses: the first 5–10 years after the last dose of the primary course, and the second 10 years later.
• Give a booster dose to anyone who has not received two booster doses at appropriate intervals.
• Give a booster dose to anyone who has been fully vaccinated, has not received a booster dose in the last 10 years, and is travelling to areas where medical attention may not be accessible.

In depth

• Pain, swelling, or redness at the injection site are common and may occur more frequently following subsequent doses. A small painless nodule may form at the injection site; this usually disappears and is of no consequence.
• Confirmed anaphylaxis is extremely rare.

In depth