TETANUS PREVENTION

  • All children should be vaccinated against tetanus during routine childhood immunization using the DPT-HepB-Hib vaccine at 6, 10, and 14 weeks of age (see above)
  • Neonatal tetanus is prevented by routinely immunising all pregnant women/women of child- bearing age (15–45 years) against tetanus with Tetanus Toxoid vaccine

PROPHYLAXIS AGAINST NEONATAL TETANUS

  • Ensure hygienic deliveries, including proper cutting and care of umbilical cords through the use of skilled birth
    attendants
  • Immunise all pregnant women/women of child- bearing age (15 – 45 years) against tetanus with Tetanus Toxoid vaccine (TT)
  • Give TT vaccine 0.5 mL IM into the upper arm as per the recommended schedule below:

Routine TT vaccine schedule and the period of protection

TT DOSE WHEN GIVEN DURATION AND
LEVELS
OF PROTECTION
TT1 At first contact with woman
of childbearing age or as early
as possible during pregnancy
None
TT2 At least 4 weeks after TT1 3 years;
80% protection
TT3 At least 6 months after TT2 5 years;
95% protection
TT4 At least 1 year after TT3 10 years;
99% protection
TT5 At least 1 year after TT4 30 years;
99% protection

VACCINATION AGAINST ADULT TETANUS

  • High risk groups such as farm workers, military personnel, miners, safe male circumcision clients, should be
    vaccinated as in the table above (if not fully immunized) and given regular boosters every 10 years
  • Patients at risk of tetanus as a result of contaminated wounds, bites, burns, and victims of road traffic accidents
    be given Antitetanus Immunoglobulin (TIG) and then be vaccinated as indicated in the table below

TREATMENT

General measures

  • Ensure adequate surgical toilet and proper care of
    wounds

Passive immunization: give to any patient at risk, except if fully immunized and having had a booster within the last 10 years

  • Give IM tetanus immunoglobulin human (TIG):
    Child <5 years: 75 IU Child 5-10 years: 125 IU Child >10 years/adult: 250 IU
  • Double the dose if heavy contamination suspected or if >24 hours since injury was sustained

Alternative – only if TIG not available:

  • Antitetanus serum (tetanus antitoxin) 1,500 IU deep SC or IM

Active immunization

Unimmunised or partially immunised patients:

  • Give a full course of vaccination for those who are not immunized at all (3 doses 0.5 mL IM at
    intervals of 4 weeks)

Fully immunized patients with booster >10 years before:

  • Give one booster dose of TT 0.5 mL intramuscularly

Fully immunised patients who have had a booster dose within the last 10 years

  • A booster is NOT necessary
Note
  • Giving TIG or TT to a fully immunised person may cause an unpleasant reaction, e.g., redness, itching, swelling, and fever, but with a severe injury this is justified