Tetanus and Diphtheria
The combined tetanus and diphtheria toxoid vaccine (Td) is highly effective; it is used for both primary and booster immunization of adults. The pediatric vaccine, diphtheria-tetanus-pertussis (DTP), has been replaced with the newer pediatric vaccine, DTaP (diphtheria and tetanus toxoid with acellular pertussis). Tdap, which contains a lower concentration of diphtheria toxoid and acellular pertussis than does DTaP, is recommended in the United States as a one-time booster for all adults aged 19–64 years, and particularly for all health care professionals and anyone caring for infants younger than 12 months. Young adults should also receive a booster dose of Td every 10 years. If serious doubt exists about the completion of a primary series of immunizations, 2 doses of the combined toxoids should be given intramuscularly at monthly intervals, followed by a third dose 6–10 months later. Thereafter, a booster dose of 0.5 mL should be given at 10-year intervals.
In wound management of tetanus, previously immunized persons with severe wounds should receive a booster if more than 5 years has elapsed since the last injection. The management of previously unimmunized patients with severe wounds should include tetanus immunoglobulin as well as Td. Although tetanus is uncommon, more than 60% of cases occur in persons older than 60 years. Therefore, older adults should be given a single booster at age 65. Pregnant women should receive one dose of Tdap during each pregnancy.
Excerpted from BCSC 2020-2021 series: Section 1 - Update on General Medicine. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.