Immunization Schedule, Adults (cont.)
Tetanus-Diphtheria; Tetanus-Diphtheria-Pertussis (Td/Tdap)
Tetanus is disease caused by bacteria. These bacteria live in all outdoor environments, most commonly in soil. Any open injury to the skin (for example, from a dirty cut, puncture wound, or animal bite) can produce a port of entry into the body. Once inside, the bacteria may germinate and produce a poisonous substance that interferes with nerve conduction. This can result in uncontrolled muscle spasms and may be fatal. Adults younger than 65 years may receive the tetanus, reduced diphtheria, and pertussis vaccine (Tdap) as a one-time alternative to tetanus and diphtheria (Td) if the pertussis component is indicated. The combination vaccine (Tdap) is composed of vaccines against diphtheria, tetanus (lockjaw), and pertussis, another bacterial disease (whooping cough). This vaccine is given routinely to children and is recommended for adults under 65 years of age who have never received a dose of Tdap.
- The incubation period (time from exposure to the bacteria to symptoms) is 48 hours to three or more weeks, with a median of seven days. With such a long incubation period, it is not surprising that the victim may not even remember the wound. The most common symptom is stiffness of the jaw (that's why tetanus is also called lockjaw). Neck stiffness and difficulty swallowing are also common. Complications include airway obstruction, respiratory arrest, heart failure, urinary retention, and constipation due to spasms of the muscles that control the release of urine and bowel.
- In the United States, most tetanus cases occur in those who are unvaccinated. Elderly people, newborns, immigrant workers, and injection drug users are at a greater risk.
Diphtheria is an infection caused by bacteria. The bacteria usually attack the respiratory tract, especially the throat. Toxins produced by the bacteria cause damage to nerve fibers and to the heart that can result in an irregular or very slow heartbeat or heart failure.
- Who gets the vaccine: Children are given the standard vaccine for tetanus and diphtheria plus protection against pertussis (whooping cough). For adults, a booster shot of just tetanus and diphtheria (Td) is needed every 10 years after the primary series in childhood. Because tetanus can cause death, a shot should be given within the first three days of a suspicious injury whenever you cannot remember when you had your last tetanus shot or if more than five years has passed since your last booster shot. The vaccine is for all adolescents and adults.
- When given: A booster dose is needed every 10 years after the primary doses given during childhood. For people with suspicious wounds, boosters are given if the last shot was more than five years before the injury. Certain clean, minor wounds may not require a booster if the last booster was within 10 years.
- Side effects: Pain, redness, swelling may occur at
the site of the shot. Fever, drowsiness, anxiousness, and loss of appetite
- The vaccine should not be given to people who have had major reactions to the vaccine or any of its components in the past. Pregnant or breastfeeding women should receive the vaccine.
Gregory L Walker, MD, FACEP, Ped EM
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