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.
Tetanus vaccine as a single antigen is no longer available in New Zealand. It is only available in combination with other vaccines.
Other tetanus toxoid-containing vaccines registered (approved for use) and available (marketed) in New Zealand are:
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.
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
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.
The dose of DTaP-IPV-HepB/Hib, DTaP-IPV, Tdap and Td is 0.5 mL administered by intramuscular injection (see section 2.3).
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.)