The tetanus vaccine protects against a potentially life-threatening bacteria called Clostridium tetani that releases the tetanus toxin. This bacteria is found in the environment in soil or manure worldwide and enters the body via any scratches, puncture wounds, burns or other skin breaks. It’s a significant cause of neonatal death in some African countries, but part of the vaccination programme offered to all babies in the UK. Symptoms of tetanus toxin infection include muscle spasms and stiffness or rigidity. This stiffness affects the jaw (causing lockjaw) and neck first, before affecting the rest of the body, and usually requiring life support.
The tetanus vaccine is offered as part of the usual UK vaccination programme for babies, and is given combined with other injections at 2 months, 3 months and 4 months old. If it is delayed or interrupted for any reason, this course can be resumed at any point in life, although your practice nurse will change the dose for those over the age of 10. At least one month should be allowed between each of the three vaccines. For most babies, tetanus is included in the vaccine package containing vaccines against diphtheria, pertussis (whooping cough), polio, hepatitis B and haemophilus influenza b.
A booster is a smaller dose of the original vaccine, and reinforces the immune response established with the first set of vaccines, to give you continued protection against tetanus bacteria. The first booster dose is routinely offered to those less than 10, and it should be at least 3 years since your child received their last vaccine. For children following the UK programme, this is usually at 3 years and 4 months old, and is given alongside a polio vaccine booster. Again, children over the age of 10 and adults can play catch-up – your practice nurse will be able to advise. The second booster dose should be given 10 years after the first booster, and, again, is given alongside a polio vaccine booster. Any open wound can put you at risk of tetanus, but those that are likely to be contaminated with debris from the ground or a puncture wound, burn or fracture with skin break are at higher risk. Road traffic accidents, gardening accidents or other outdoor injuries and animal bites or scratches are considered high risk. If vaccination status is unclear or someone has not completed their tetanus vaccination schedule, they should be offered a tetanus booster urgently. This can be administered by your nurse or by a hospital nurse or doctor, if you attend there. You should ensure you get this ASAP after any injury causing an open wound.
Those who inject street or party drugs are at increased risk, as they may use needles contaminated with tetanus, and they may have other skin infections or abscesses that encourage the growth of tetanus bacteria. Those who are immunocompromised at the time of a tetanus vaccine – either through a medical condition or medication – may not mount a sufficient response, so they may need to repeat this once they have recovered or ceased their medication course. They should still proceed with the tetanus vaccine if due at the time they are immunosuppressed. It's safe for pregnant or breastfeeding women, a combined injection is offered routinely between week 16 and 32 of pregnancy alongside pertussis, diphtheria and polio boosters.
There are very few reasons someone cannot receive the tetanus vaccine – it's not a live vaccine, so you can’t catch tetanus from it. Previous serious allergic reaction to the tetanus jab or any of its components requires expert advice about giving further injections, but anaphylactic reactions – where there is difficulty in breathing – are extremely rare. Most injections can feel sore as the needle goes in, and for a few hours of days afterwards. You can get pain, swelling and redness around the injection site, and a small painless nodule that usually disappear with time. As the immune system mounts a response, combined childhood vaccines can cause fever and distress. Paracetamol and/or ibuprofen can help relieve pain and a high temperature. Vaccination should be postponed if you or your child has a feverish illness, but not mild illness without a fever, and the risks need to be weighed against the benefits if you are feverish and you incur a contaminated wound.