|Target disease||Clostridium tetani|
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Tetanus vaccine is a vaccine composed of deactivated tetanus toxins. This vaccine is immunogenic but not pathogenic and is used to prevent an individual from contracting tetanus. Tetanus, also known as lockjaw, is a disease caused by the bacterium Clostridium tetani which enters the body through open wounds and releases a poison called tetanospasmin. This is a potentially deadly disease because the poison attacks the nervous system blocking nerve signals from the spinal cord to and from the muscles. However this disease is preventable through injecting multiple doses of vaccines and administering the recommended booster shot every ten years. It is on the World Health Organization's List of Essential Medicines, a list of the most important medication needed in a basic health system.
Tetanus has become uncommon in the United States, with an average of 29 reported cases per year from 1996 through 2009. Nearly all cases of tetanus are among those who have never received a tetanus vaccine, or adults who don't stay up to date on their 10-year booster shots.
Since the discovery and productions of the tetanus vaccines, the occurrence of tetanus, diphtheria, and pertussis has decreased. Using US population derived figures, following vaccination, 95% of people are protected from diphtheria, 80 to 85% of people are protected from pertussis, and 100% of people are protected from tetanus. Before the vaccine there was an average of 580 annual cases of tetanus and 472 annual deaths from tetanus. But since the vaccine there is an average of 41 annual cases of tetanus and 4 annual deaths from tetanus. This is 93% reduction in occurrence of tetanus and a 99% reduction in fatalities resulting from tetanus.
Guidelines on prenatal care in the United States state that, if an urgent need for tetanus protection occurs during pregnancy, Td vaccine should be administered. If no urgent need arises and the woman has previously received tetanus vaccine, Td vaccination should be delayed until the postpartum period. All postpartum women who have not received Td or Tdap vaccine in the last two years are recommended to receive Tdap prior to discharge after delivery. It is recommended for pregnant women who have never received tetanus vaccine (i.e., have never received DTP, DTaP or DT as child or Td or TT as adult) to receive a series of three Td vaccinations starting during pregnancy to ensure protection against maternal and neonatal tetanus. In such cases, administration of Tdap is recommended after 20 weeks' gestation, and in earlier pregnancy a single dose of Tdap can be substituted for one dose of Td, and then the series completed with Td.
The first vaccine is administered at infancy. The baby is injected with the DTaP vaccine which is 3 inactive toxins in one injection. DTaP protects against diphtheria, pertussis, and tetanus. This vaccine is safer than the previously used DTP.
Booster shots are important because lymphocyte production (antibodies) is not at a constant high rate of activity. This is because after the introduction of the vaccine when lymphocyte production is high, the production activity of the white blood cells will start to decline. The decline in activity of the T-helper cells means that there must be a booster to help keep the white blood cells active.
Td and Tdap are the booster shots given every ten years to maintain immunity for adults nineteen years of age to sixty-five years of age
Tdap is given as a onetime, first time only dose that includes the tetanus, diphtheria, and acellular pertussis vaccinations. This should not be administered to those who are under the age of eleven or over the age of sixty-five.
Td is the booster shot given to people over the age of seven and includes the tetanus and diphtheria toxoids. However, Td has less of the diphtheria which is why the "d" is lower case and the "T" is capitalized.
It is important to understand that booster shots should be administered before the age of sixty-five and that one of these booster shots should be Tdap while the rest are Td.
Each vaccine has a specific injection site and time of injections (however, the time of injection does have a tolerance amount because each individual is different). Because DTaP and DT are administered to infants, the recommended location for injection is the anterolateral thigh muscle. However, these vaccines can be injected into the deltoid muscle if necessary. DTaP occurs in four doses. The first dose should be around two months of age, the second at four months age, the third at six months of age, and the fourth from fifteen months of age to eighteen months of age. There is a recommended fifth dose to be administered to four to six year olds.
TD and TDaP are to be administered to older children, adolescents, and adults so it can therefore be injected into the deltoid muscle. These are boosters and are therefore to be administered at least every ten years. And it is safe to have shorter intervals between a single dose of Tdap and a dose of the Td booster.
As with any medications, there are side effects to these vaccines. The common side effects include fever, redness, swelling around the injections, and soreness or tenderness around the injection site. There are reported cases of body aches and tiredness following the Tdap. Td / Tdap can cause painful swelling of the arm and reactions around the injections site, (up to about 3 in 100) There have been reported cases in Denmark of more serious reactions to the vaccines including “heavy edematous local reactions, urticaria, arthralgia, nephrosis, and anaphylactic shock”. However, none of these cases resulted in fatality.
Mechanism of action
The type of vaccination for this disease is called artificial active immunity. This type of immunity is generated when a dead or weakened version of the disease enters the body causing an immune response which includes the production of antibodies. This is beneficial to the body because this means that if the disease is ever introduced into the body, the immune system will recognize the antigen and produce antibodies more rapidly.
The first inactive tetanus toxoid was discovered and produced in 1924. This vaccine was proven to be successful when it was used to prevent tetanus in the military during World War II. DTP (which is the vaccine for diphtheria, tetanus, and pertussis) was first used in 1930 and was continued until 1991 when it was replaced with a different form which included the acellular pertussis vaccine because of safety concerns. Half of those who received the DTP vaccine had redness, swelling, and pain around the injection site which convinced researchers to find a replacement vaccine.
Two new vaccines were launched in 1992. These combined tetanus and diphtheria with acellular pertussis (TDaP or DTaP) which could be given to adolescents and adults (as opposed to previously when the vaccine was only given to children).
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