TETANUS-DIPHTHERIA VACCINE (Td) - MSF Medical Guidelines

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 (a)Citation a.2 doses 4 weeks apart then 3 additional doses administered according to the vaccination schedule below. or complete tetanus vaccination
Other	None	Td 1 booster dose	Td 1 booster dose	Initiate (a)Citation a.2 doses 4 weeks apart then 3 additional doses administered according to the vaccination schedule below. or complete tetanus vaccination and administer tetanus immunoglobulin

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.