When Are Tetanus Shots Needed?

For those people in Houston recovering from hurricane Harvey's damage, or a first-responder helping in the recovery effort, health officials are suggesting you check your immunization for tetanus.

This means, do you know when you last had a tetanus shot?

If you are working in the floodwaters full of debris, too murky to clearly see, your risk of a puncture wound is real.

"Routine tetanus boosters are sufficient," said Chris Van Deusen, director of media relations for the Texas Department of State Health Services.

"We're anticipating possible requests for tetanus vaccine for unvaccinated people."

“In decades past, the concern that people caught up in flooding might have let their tetanus protection lapse led to recommendations to vaccinate after hurricanes,’ said Mark K. Slifka, Ph.D., a professor at the Oregon National Primate Research Center.

"But that didn’t always happen and there were no surges in tetanus cases after natural disasters.”

Both the Centers for Disease Control and Prevention (CDC) and the Occupational Health and Safety Administration recommend that workers involved in flood cleanups ensure that their tetanus vaccination status is up to date, every ten years.

Today, tetanus is uncommon in the United States, with an average of 30 reported cases each year. Nearly all cases of tetanus are among people who have never received a tetanus vaccine.

The disease is particularly common and serious in newborn babies and their mothers, when the mothers are unprotected from tetanus by the vaccine, tetanus toxoid.

The CDC reports that 10 percent of tetanus cases are fatal.

But, new research suggest tetanus shots could deliver protection for 10, 20 and possibly even 30 years.

“We have always been told to get a tetanus shot every 10 years, but actually, there is very little data to prove or disprove that timeline,” said Dr. Slifka.

“When we looked at the levels of immunity among adults, we realized that antibody titers against tetanus lasted much longer than previously believed.”

Dr. Slifka’s research produced mathematical models combining antibody magnitude and duration predict that 95% of the population will remain protected against tetanus for ≥30 years, without requiring another booster vaccination.

Dr. Slifka’s revised vaccination schedule could also have a substantial impact on U.S. healthcare costs. His data suggests a reduction of approximately $280 million per year in costs.

Of course, this whole system only works when kids get the recommended five doses during childhood - and just because tetanus and diphtheria are rare in developed countries, it doesn't make them any less deadly.

“Over the last decade, we have seen that mainly recent immigrants or older people who did not receive at least three doses of the tetanus vaccine are the ones at highest risk for a fatal case of tetanus,” said Dr. Slifka.

Tetanus is caused by Clostridium tetani, a spore-forming bacterium that is found in soil. When those spores enter the body, often through a puncture wound, the bacteria start to produce toxins that induces muscle contractions, especially in the jaw and neck.

Tetanus vaccines became commercially available in the United States in 1938, but routine vaccination was not widely practiced until the mid-1940s.

Deaths attributable to tetanus have declined 99 percent since the prevaccine era.

There are four kinds of vaccines used to protect against tetanus, all of which are combined with vaccines for other diseases:

• DTaP: Pediatric diphtheria, tetanus, and acellular pertussis (whooping cough) vaccine (Spanish)
• DT: Pediatric diphtheria and tetanus vaccine
• Td: Older children and adults tetanus and diphtheria vaccine (Spanish)
• Tdap: Older children and adults tetanus, diphtheria, and acellular pertussis (whooping cough) vaccine

Most pharmacies offer various tetanus vaccines. The CDC Vaccine Price List provide the private sector vaccine prices for general information.

Discounts for vaccines can be found here.

These researchers did not disclose any conflicts of interest:  Erika Hammarlund Archana Thomas Elizabeth A. Poore Ian J. AmannaAbby E. Rynko Motomi Mori Zunqiu Chen Mark K. Slifka.

This research was supported in part by the National Institutes of Health (Public Health Service grant R01 AI098723 to E. H., A. T., E. A. P., A. E. R., and M. K. S. and grant U01 AI082196 to E. H., A. T., E. A. P., I. J. A., and M. K. S.), the Oregon Clinical & Translational Research Institute Biostatistics & Design Program (M. M. and Z. C.), and the Oregon National Primate Research Center (grant, 8P51 OD011092-53 to M. K. S.).