19 Tetanus

19.4 Vaccines

Tetanus immunisation protects by stimulating the production of antitoxin, providing immunity against the effects of the toxin. It does not prevent C. tetani growing in a contaminated wound. The tetanus vaccine is prepared from cell-free toxin treated with formaldehyde to produce a toxoid. The toxoid is adsorbed onto an aluminium salt adjuvant to improve immunogenicity.

19.4.1 Available vaccines

Funded vaccines

Tetanus vaccine as a single antigen is no longer available in New Zealand. It is only available in combination with other vaccines.

The tetanus toxoid-containing vaccines funded as part of the Schedule are:
  • DTaP-IPV-HepB/Hib (Infanrix-hexa, GSK): diphtheria, tetanus, acellular pertussis, inactivated polio, hepatitis B and Haemophilus influenzae type b vaccine
  • DTaP-IPV (Infanrix-IPV, GSK): diphtheria, tetanus, acellular pertussis and inactivated polio vaccine
  • Tdap (Boostrix, GSK): a smaller adult dose of diphtheria and pertussis vaccine, together with tetanus vaccine
  • ​Td (ADT Booster, Seqirus (NZ) Ltd): a smaller adult dose of diphtheria vaccine together with tetanus vaccine.
See section 5.4.1 for more detailed vaccine information.

Other vaccines

Other tetanus toxoid-containing vaccines registered (approved for use) and available (marketed) in New Zealand are:

19.4.2 Efficacy and effectivenessTop

Efficacy and effectiveness

Tetanus toxoid vaccine administered to pregnant women can prevent tetanus in their newborns (neonatal tetanus). Subsequent field assessments of the efficacy of two or more tetanus toxoid doses using data collected during neonatal tetanus mortality surveys demonstrated effectiveness of 70–100 percent. A systematic review and meta-analysis concluded that immunisation of pregnant or childbearing-age women with two or more doses of tetanus toxoid reduces neonatal tetanus mortality by 94 percent (95% CI: 80–98).2

Tetanus in adults is too rare for vaccine efficacy to be tested in a clinical trial. However, the effectiveness of tetanus vaccine was clearly demonstrated in World War II, when only 12 cases of tetanus occurred among the 2.7 million wounded US army personnel (0.44 per 100,000), compared to 70 cases out of 520,000 wounded in World War I (13.4 per 100,000).2 Of the 12 cases, only four had completed primary immunisation. Immunised cases have less severe disease and a lower case fatality.

Duration of protection

In most studies, 100 percent of infants have protective levels of tetanus antibody after three doses of vaccine given at intervals of four weeks or longer. The duration of antibody persistence depends on the initial antibody level. Calculations of tetanus antibody decay have shown that a three-dose primary schedule in infancy will provide protection for at least five years, and a booster at five years will provide protection for at least another 21 years.3

(See also sections 5.4.2 and 14.4.2).

19.4.3 Transport, storage and handlingTop

Transport according to the National Guidelines for Vaccine Storage and Distribution.4 Store at +2oC to +8oC. Do not freeze.

DTaP-IPV-HepB/Hib and Td should be stored in the dark.

DTaP-IPV-HepB/Hib (Infanrix-hexa) must be reconstituted by adding the entire contents of the supplied container of the DTaP-IPV-HepB vaccine to the vial containing the Hib pellet. After adding the vaccine to the pellet, the mixture should be shaken until the pellet is completely dissolved. Use the reconstituted vaccine as soon as possible. If storage is necessary, hold at room temperature for up to eight hours.

19.4.4 Dosage and administrationTop

The dose of DTaP-IPV-HepB/Hib, DTaP-IPV, Tdap and Td is 0.5 mL administered by intramuscular injection (see section 2.3).

Co-administration with other vaccines

DTaP-IPV-HepB/Hib, DTaP-IPV, Tdap and Td can be administered simultaneously (at separate sites) with other vaccines or immunoglobulins.

(See also section 14.4.4 for information about co-administration of DTaP-IPV-HepB/Hib and PCV13.)