TETANUS-DIPHTHERIA VACCINE (Td)


Indications

– Prevention of tetanus in wound management
– Prevention of tetanus and diphtheria in pregnant women or women of childbearing age
– Prevention of tetanus and diphtheria in children over 4 years and adolescents (booster dose after complete primary vaccination)

Composition, forms, route of administration

– Bivalent vaccine combining tetanus toxoid and diphtheria toxoid (containing reduced dose of diphtheria toxoid)
– Suspension for injection in multidose vial, for IM injection into the deltoid muscle

Dosage and vaccination schedule

– Child and adult: 0.5 ml per dose

– Prevention of tetanus in wound management


Type of wound

Complete vaccination (3 or more doses)
Time since administration of last dose

Incomplete vaccination (less than 3 doses)
or no vaccination
or unknown status

< 5 years

5-10 years

> 10 years

Minor, clean

None

None

Td
1 booster dose

Initiate* or complete tetanus vaccination

Other

None

Td
1 booster dose

Td
1 booster dose

Initiate* or complete tetanus vaccination
and administer tetanus immunoglobulin

* 2 doses 4 weeks apart then 3 additional doses administered according to the vaccination schedule below.

– Prevention of tetanus in pregnant women and women of childbearing age
5 doses administered according to the schedule below:

Td1

On first contact with the health care system or as soon as possible during pregnancy

Td2

At least 4 weeks after Td1

Td3

6 months to 1 year after Td2 or during the following pregnancy

Td4

1 to 5 years after Td3 or during the following pregnancy

Td5

1 to 10 years after Td4 or during the following pregnancy

In pregnant women, administer at least 2 doses before delivery: the 1st dose as soon as possible during pregnancy and the 2nd dose at least 4 weeks after the 1st  and at least 2 weeks before due date. After delivery, continue vaccination as described in the table above until the required 5 doses have been administered.

– Prevention of tetanus in children over 4 years (after complete primary vaccination and 1st booster between 12 and 23 months)
 Booster dose between 4 and 7 years then between 9 and 15 years

Contra-indications, adverse effects, precautions

– Do not administer in the event of allergic reactions after a previous dose of tetanus or diphtheria vaccine.
– Vaccination should be postponed in the event of severe acute febrile illness; minor infections are not contra-indications.
– May cause: mild local reactions (redness, pain at the injection site), fever, pain, malaise; rarely: anaphylactic reactions.
– If administered simultaneously with other vaccines, use different syringes and injection sites. 
– Pregnancy and breast-feeding: no contra-indication

Remarks

– The monovalent tetanus (TT) vaccine is used in certain national protocols. Use perferably the conjugate tetanus-diphtheria (Td) vaccine for the prevention of tetanus in children over 7 years, adolescents and adults.
– Tetanus vaccination in pregnant women and women of child bearing age protects neonates from tetanus.
– Storage: between 2 °C and 8 °C. Do not freeze -