Tetanus-diphtheria immunization for adults

General information
Tetanus (lockjaw) and diphtheria are serious bacterial infections. In some cases, they can be fatal. Tetanus bacteria are found in the soil, air and on human skin. They enter the body through breaks in the skin, injuries to the eye or burns. The bacteria produce a toxin that causes muscles to painfully tighten. This results in a "locked" jaw, which prevents the mouth from opening and may interfere with or prevent swallowing.
Diphtheria produces a thick covering in the back of the throat that can lead to difficulty breathing, paralysis or heart failure. Diphtheria bacteria are passed from person to person through droplets that are coughed, sneezed, breathed or laughed into the air.

Children are routinely immunized against these diseases, and adults need regular booster shots to maintain immunity. The vaccination contains the tetanus and diphtheria (Td) toxoids.


Recommendations
The Td vaccination is recommended for every adult.

Dose
Unvaccinated adults need three doses of tetanus to start immunity. The first and second dose should be given four to eight weeks apart, followed with a third dose six to 12 months later.
For a clean or minor wound, you need a booster if:

you have completed the initial three-part series, but your last dose was more than 10 years ago
your initial three-part series is not complete or you're unsure of your immunization status
For a contaminated or major wound, you need a tetanus vaccine if:

your last dose was more than five years before the injury
your vaccination history is unknown
you haven't completed the initial three-part series (Tetanus immune globulin, or TIG, may also be necessary and is given along with the tetanus vaccine.)

Effectiveness/booster
The vaccine provides about 95 percent protection from diphtheria and 100 percent protection from tetanus. Tetanus and diphtheria occur most often in people who have never been vaccinated or don't get the necessary booster shots. Adults who had the recommended childhood immunizations should receive a booster every 10 years, beginning at about age 25.

Side effects
The most common side effects last 24 to 48 hours and may include:
soreness, redness and swelling at the injection site
fever up to 102°F
lump at the injection site, which may last one to two weeks
frequent booster shots may cause severe swelling extending from the elbow to shoulder, which usually begins two to eight hours after the injection
very rarely, an allergic reaction, a brain disorder or brachial neuritis (prolonged pain and weakness in the upper arms)

Who should wait to receive the vaccine
The vaccine may be postponed if you have a moderate to severe acute illness.

Who should not receive the vaccine
You should not receive the vaccine if you've had a severe allergic reaction or a brain disorder after a previous tetanus-diphtheria immunization.

Pregnancy-specific information
The tetanus-diphtheria vaccine can be given during pregnancy, but preferably after the first trimester.