Who Needs Repeat Tetanus Vaccinations?

When the Tulsa, Oklahoma Health Department (THD) on May 27, 2019, offered free tetanus vaccinations to anyone affected by the recent weather events in Tulsa County, it was another example of how ‘preventing disease is easier than providing expensive treatments.’

Moreover, tetanus vaccinations after a flood aren’t just for kids, says the Centers for Disease Control and Prevention (CDC).

The need to be protected from tetanus infections does not go away with age. 

The CDC said in February 2019 that, ‘adults need to stay current with their tetanus immunity.’ 

This vaccination recommendation is based on the fact that 60 percent of the reported tetanus cases were among adults. Specifically, about 25 percent of those reported cases were among people over 65 years of age.

The CDC says most tetanus cases are reporting in people who have never received a tetanus vaccine or didn’t stay up to date on their 10-year booster shots. 

Stepping on nails or other sharp objects is one-way people are often exposed to the bacteria that causes tetanus. 

Tetanus is an infection caused by a bacterium called Clostridium tetani. Spores of tetanus bacteria are everywhere in the environment, including soil, dust, and manure. These spores develop into bacteria when they enter the body. 

Generalized tetanus is the most common form of tetanus, accounting for more than 80 percent of cases. People often call tetanus “lockjaw” because the infection often is the tightening of the jaw muscles. 

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

Since then, deaths attributable to tetanus have declined 99 percent since the prevaccine era. 

The CDC Advisory Committee on Immunization Practices committee (ACIP) routine vaccination schedule for adults is 1 dose of the Tdap vaccine, followed by a Td booster shot every 10 years for people who did not receive at least 1 dose of the Tdap vaccine at or after age 11. 

During the CDC meeting in October 2018, the recommendation for the 2nd vaccine dose of Tdap was reviewed. 

This review stemmed from concerns regarding the lower tetanus immunization rates seen in adults. And, the ACIP noted that many healthcare providers are not stocking multiple tetanus-containing vaccines. 

Currently, the ACIP recommends infants and young children receive a 5-dose series of diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccines, with one adolescent booster dose of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine. 

And, for adults who have never received a Tdap vaccination, it is also recommended they receive a booster dose of Tdap. 

Furthermore, women are recommended to receive a dose of Tdap during each pregnancy, which should be administered from 27 through 36 weeks’ gestation, regardless of the previous receipt of Tdap.

The Tdap shot is an effective and safe way to protect the mother and baby from serious illness and complications of pertussis.   

During the October 2018 meeting, the producer of the Tdap vaccine Adacel Sanofi Pasteur presented data showing that the administration of a repeated Adacel dose up to 12 years after an initial dose was safe and effective. 

Which led the ACIP to suggest broadening the recommendation to allow for any tetanus-containing vaccine to ease any barriers for providers. 

Later, on January 15th, 2019, the Food and Drug Administration (FDA) approved the expanded use of Adacel to include a repeat vaccination.   

Adacel is now the 1st and only Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis (Tdap) Vaccine Adsorbed approved in the USA for a repeat dose in people 10 through 64 years of age, 8 years or more after the first vaccination.

Recent tetanus news:

• DTaP Vaccination Effectiveness Wanes With Time
• Adults Need Vaccines, Too!

But, research published in 2017 suggested tetanus shots could deliver protection for 10, 20 and possibly even 30 years. 

Mark K. Slifka, Ph.D., a professor at the Oregon National Primate Research Center, said: “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 vaccine costs.

“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. 

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

When it comes to treating a person with tetanus, there are serval options available.

Medical experts recommend a single dose of human TIG for treatment of persons with tetanus. But, researchers have not established the optimal therapeutic dose.   

However, experts recommend 500 international units (IU), which appears to be as effective as higher doses ranging from 3,000 to 6,000 IU and causes less discomfort. 

Clinicians must administer available preparations intramuscularly, TIG preparations available in the United States are not licensed or formulated for intrathecal or intravenous use. 

Some medical experts recommend infiltration of part of the dose locally around the wound although its efficacy has not been proven. 

If TIG is not available, clinicians can use IGIV at a dose of 200 to 400 milligrams per kilogram (mg/kg). 

However, the FDA has not approved IGIV for this use.

Most pharmacies in the USA offer various tetanus vaccines, and the CDC’s Vaccine Price List publishes the private sector prices for general information.

Financial support programs can be found at Vaccine Discounts. 

Vaccines can cause side effects, which should be reported to a healthcare provider and the FDA.