Even small wounds such as a prick from a thorn can allow enough bacteria to get into the body to cause tetanus. The illness takes up to 21 days to develop, sometimes more. Therefore, you may have forgotten about a small cut before the illness starts. Tetanus in the UK is uncommon but most cases occur in people over the age of 65 years who have not been immunised against tetanus, as the immunisation was only routinely introduced in 1961.
The vaccine
For young children, tetanus vaccine is normally part of the combined DTaP/IPV(polio)/Hib vaccine – this stands for ‘diphtheria, tetanus, pertussis (whooping cough)/polio/Haemophilus influenzae type b’ vaccine, which is given as part of the routine childhood immunisation programme.
For adults and teenagers who receive tetanus immunisation, a combined tetanus, diphtheria/polio vaccine (Td/IPV(polio)) is normally used.
The vaccine stimulates your body to make antibodies against the tetanus toxin. These antibodies protect you from illness should you become infected with this bacteria.
Tetanus immunisation timetable
All children are offered tetanus immunisation as part of the routine immunisation programme. A full course of tetanus immunisation consists of five doses of vaccine as follows:
Children Adults (who have not been immunised as a child)
Primary Course Three doses of vaccine – as DTaP/IPV(polio)/Hib at two, three and four months of age. Three doses of vaccine – as Td/IPV(polio), each one month apart.
4th dose Three years after the primary course – as part of the DTaP/IPV(polio) pre-school booster at 3 years and four months to 5 years. 5 years after the primary course – as Td/IPV(polio).
5th dose Aged 13-18 years – the school leaver booster – as Td/IPV(polio). 10 years after 4th dose – as Td/IPV(polio).
The primary course of three injections gives good protection for a number of years. The fourth and fifth doses (boosters) maintain protection. After the fifth dose, immunity remains for life and you do not need any further boosters (apart from some travel situations – see ‘I am going abroad’, below).
Adults – are you immunised?
Some adults have not been fully immunised against tetanus because routine immunisation for children was not introduced until 1961. Men serving in the armed forces from 1938 onwards were offered tetanus immunisation. So, some older people may still be at risk.
See your practice nurse if you think that you are not fully immunised against tetanus (that is – if you have not had five injections in total). The course does not need to be started again if an injection is delayed. A late injection is sufficient to catch up, even if you have it years after it was due.
Do I need a dose of tetanus vaccine after cuts, bites, etc?
If you are not immunised or up-to-date with boosters then an injection of vaccine is usually advised.
If you are up-to-date with tetanus immunisations, then you do not need a tetanus vaccine.
If your wound or injury is considered to be high risk for tetanus (for example, where there has been significant contact with soil or manure) then an injection of human tetanus immunoglobulin is usually given, regardless of whether your have been immunised against tetanus or not. This gives extra protection against tetanus.
I am going abroad – do I need a tetanus immunisation?
Usually not if you are up-to-date with your immunisations. However, if you are to travel to areas where medical attention may not be available, then a dose of vaccine may be advised. This is even if you have had five previous injections. In particular, if it has been more than 10 years since your last injection. This is a precautionary measure in case you have a very dirty wound and do not receive antiserum. Your doctor or practice nurse will advise.
Are there any side-effects from the tetanus vaccine?
It is common to get a little redness and swelling around the injection site, which goes after a few days. Some people feel slightly unwell for a day or so, with a mild headache, slight aching of the muscles and a mild fever. Severe reactions are extremely rare.
Who should not receive the tetanus vaccine?
If you are unwell with an illness causing a fever, it is wise to postpone an injection until the illness has gone (except if the dose is needed after a cut or wound). Also, you should not have another injection of vaccine if a previous injection caused a severe reaction. The tetanus vaccine is safe if you are pregnant or breast-feeding.
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