Tetanus vaccine: Difference between revisions

{{Short description|Vaccines used to prevent tetanus}}

{{Use dmy dates|date=November 2022}}

| Verifiedfields = changed

| verifiedrevid = 415806441

| image = DPT-IPV-japan Quattro back.jpg

| caption = Tetanus vaccination is often administered via combination [[DPT vaccine]]s

<!-- Vaccine data -->

| type = vaccine

| target = [[Tetanus]]

| vaccine_type = toxoid

<!-- Clinical data -->

| tradename =

| MedlinePlus = a682198

| DailyMedID = Tetanus

| pregnancy_AU = <!-- A / B1 / B2 / B3 / C / D / X -->

| pregnancy_AU_comment =

| pregnancy_category=

| routes_of_administration = injection

| class =

| ATCvet =

| ATC_prefix = J07

| ATC_suffix = AM01

| ATC_supplemental =

<!-- Legal status -->

| legal_AU = <!-- S2, S3, S4, S5, S6, S7, S8, S9 or Unscheduled -->

| legal_AU_comment =

| legal_BR = <!-- OTC, A1, A2, A3, B1, B2, C1, C2, C3, C4, C5, D1, D2, E, F -->

| legal_BR_comment =

| legal_CA = <!-- OTC, Rx-only, Schedule I, II, III, IV, V, VI, VII, VIII -->

| legal_CA_comment =

| legal_DE = <!-- Anlage I, II, III or Unscheduled -->

| legal_DE_comment =

| legal_NZ = <!-- Class A, B, C -->

| legal_NZ_comment =

| legal_UK = <!-- GSL, P, POM, CD, CD Lic, CD POM, CD No Reg POM, CD (Benz) POM, CD (Anab) POM or CD Inv POM / Class A, B, C -->

| legal_UK_comment =

| legal_US = Rx-only

| legal_US_comment =

| legal_EU = Rx-only

| legal_EU_comment = <ref>{{cite web | title = Active substance: diphtheria / tetanus vaccines (adsorbed), diphtheria vaccines (adsorbed) | work = List of nationally authorised medicinal products | publisher = European Medicines Agency | date = 14 January 2021 | url = https://www.ema.europa.eu/documents/psusa/diphtheria/tetanus-vaccines-adsorbed-diphtheria-vaccines-adsorbed-list-nationally-authorised-medicinal-products/00001128/202005_en.pdf}}</ref>

| legal_UN = <!-- N I, II, III, IV / P I, II, III, IV -->

| legal_UN_comment =

| legal_status = <!-- For countries not listed above -->

<!-- Identifiers -->

| CAS_number = 93384-51-1

| ChemSpiderID_Ref = {{chemspidercite|changed|chemspider}}

| ChemSpiderID = none

<!-- Chemical and physical data -->

<!-- Definition and medical uses -->

'''Tetanus vaccine''', also known as '''tetanus toxoid''' ('''TT'''), is a [[toxoid]] vaccine used to prevent [[tetanus]].<ref name=WHO2017>{{cite journal | vauthors = ((World Health Organization)) | title = Tetanus vaccines: WHO position paper – February 2017 | journal = Weekly Epidemiological Record | date = February 2017 | volume = 92 | issue = 6 | pages = 53–76 | hdl = 10665/254583 | url = https://www.who.int/immunization/policy/position_papers/pp_tetanus_2017_summary.pdf | pmid = 28185446 | author-link = World Health Organization | hdl-access = free }}</ref> During childhood, five doses are recommended, with a sixth given during adolescence.<ref name=WHO2017/>

After three doses, almost everyone is initially immune,<ref name=WHO2017/> but additional doses every ten years are recommended to maintain immunity.<ref name=Pink2015>{{cite book | veditors = Hamborsky J, Kroger A, Wolfe S |title=Epidemiology and Prevention of Vaccine-Preventable Diseases|year=2015|publisher=[[Centers for Disease Control and Prevention]] (CDC)|edition=13th |url=https://www.cdc.gov/vaccines/pubs/pinkbook/tetanus.html|chapter=Chapter 21: Tetanus |url-status=live|archive-url=https://web.archive.org/web/20170413232437/https://www.cdc.gov/vaccines/pubs/pinkbook/tetanus.html|archive-date=13 April 2017}} {{PD-notice}}</ref> A booster shot should be given within 48 hours of an injury to people whose immunization is out of date.<ref>{{cite web|title=Puncture wounds: First aid|url=http://www.mayoclinic.org/first-aid/first-aid-puncture-wounds/basics/art-20056665|website=Mayo Clinic|access-date=6 December 2015|date=4 February 2015|url-status=live|archive-url=https://web.archive.org/web/20151208143120/http://www.mayoclinic.org/first-aid/first-aid-puncture-wounds/basics/art-20056665|archive-date=8 December 2015}}</ref>

Confirming that pregnant women are up to date on tetanus immunization during each pregnancy can prevent both maternal and [[neonatal tetanus]].<ref name=WHO2017/><ref name=cdctdap /><ref name="pmid31971933">{{cite journal |vauthors=Havers FP, Moro PL, Hunter P, Hariri S, Bernstein H |title=Use of Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis Vaccines: Updated Recommendations of the Advisory Committee on Immunization Practices - United States, 2019 |journal=MMWR Morb. Mortal. Wkly. Rep. |volume=69 |issue=3 |pages=77–83 |date=January 2020 |pmid=31971933 |doi=10.15585/mmwr.mm6903a5 |pmc=7367039 |url=https://www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6903a5-H.pdf }} {{PD-notice}}</ref>

<!-- Safety -->

The vaccine is very safe, including during [[pregnancy]] and in those with [[HIV/AIDS]].<ref name=WHO2017/>

Redness and pain at the site of injection occur in between 25% and 85% of people.<ref name=WHO2017/> Fever, feeling tired, and minor muscle pain occurs in less than 10% of people.<ref name=WHO2017/> [[Anaphylaxis|Severe allergic reactions]] occur in fewer than one in 100,000 people.<ref name=WHO2017/>

<!-- Formulation -->

A number of vaccine combinations include the tetanus vaccine, such as [[DTaP]] and [[Tdap]], which contain [[diphtheria vaccine|diphtheria]], tetanus, and [[pertussis vaccine]]s, and DT and Td, which contain [[diphtheria vaccine|diphtheria]] and tetanus vaccines.<ref name=CDC2015/> DTaP and DT are given to children less than seven years old, while Tdap and Td are given to those seven years old and older.<ref name=CDC2015/><ref>{{cite web | title=Recommended Child and Adolescent Immunization Schedule for ages 18 years or younger, United States, 2020 | website=[[Centers for Disease Control and Prevention]] (CDC) | date=3 February 2020 | url=https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html | access-date=6 February 2020}} {{PD-notice}}</ref> The lowercase d and p denote lower strengths of diphtheria and pertussis vaccines.<ref name=CDC2015>{{cite web |url=https://www.cdc.gov/vaccines/vpd-vac/tetanus/default.htm |title=Vaccines: VPD-VAC/Tetanus/main page |publisher=[[Centers for Disease Control and Prevention]] (CDC) |access-date=10 February 2015 |url-status=live |archive-url=https://web.archive.org/web/20150212102845/https://www.cdc.gov/vaccines/vpd-vac/tetanus/default.htm |archive-date=12 February 2015 }} {{PD-notice}}</ref>

<!-- Society and culture -->

Tetanus [[antiserum]] was developed in 1890, with its protective effects lasting a few weeks.<ref>{{cite book | vauthors = Gradmann C, Simon J |title=Evaluating and Standardizing Therapeutic Agents, 1890-1950 |date=2010 |publisher=Springer |isbn=9780230285590 |page=53 |url=https://books.google.com/books?id=uuWFDAAAQBAJ&pg=PA53}}</ref><ref>{{cite book | vauthors = Jones BR |title=Pharmacology for Student and Pupil Nurses and Students in Associated Professions |date=2016 |publisher=Elsevier |isbn=9781483141312 |page=162 |url=https://books.google.com/books?id=fFl-DAAAQBAJ&pg=PA162}}</ref> The tetanus toxoid vaccine was developed in 1924, and came into common use for soldiers in [[World War II]].<ref name=WHO2017/><ref>{{cite book| vauthors = Macera C |title=Introduction to Epidemiology: Distribution and Determinants of Disease|date=2012|publisher=Nelson Education|isbn=9781285687148|page=251|url=https://books.google.com/books?id=U8FuCgAAQBAJ&pg=PA251|url-status=live|archive-url=https://web.archive.org/web/20160305040732/https://books.google.com/books?id=U8FuCgAAQBAJ&pg=PA251|archive-date=5 March 2016}}</ref> Its use resulted in a 95% decrease in the rate of tetanus.<ref name=WHO2017/> It is on the [[WHO Model List of Essential Medicines|World Health Organization's List of Essential Medicines]].<ref name="WHO21st">{{cite book | vauthors = ((World Health Organization)) | title = World Health Organization model list of essential medicines: 21st list 2019 | year = 2019 | hdl = 10665/325771 | author-link = World Health Organization | publisher = World Health Organization | location = Geneva | id = WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO | hdl-access=free }}</ref><ref name="WHO22nd">{{cite book | vauthors = ((World Health Organization)) | title = World Health Organization model list of essential medicines: 22nd list (2021) | year = 2021 | hdl = 10665/345533 | author-link = World Health Organization | publisher = World Health Organization | location = Geneva | id = WHO/MHP/HPS/EML/2021.02 | hdl-access=free }}</ref>

{{TOC limit|3}}

==Medical uses==

===Effectiveness===

[[File:Tetanus-deaths-by-age-group.png|thumb|upright=1.6|Decrease in tetanus deaths by age group between 1990 and 2017<ref>{{cite web |title=Deaths from tetanus, by age |url=https://ourworldindata.org/grapher/tetanus-deaths-by-age-group |website=Our World in Data |access-date=13 January 2020}}</ref>]]

Vaccination confers near-complete protection from tetanus, provided the individual has received their recommended booster shots.<ref name=VaccInfo2011>{{cite book |vauthors=((Centers for Disease Control and Prevention)) | author-link=Centers for Disease Control and Prevention |title=Epidemiology and Prevention of Vaccine-Preventable Diseases (CDC, Epidemiology and Prevention of Vaccine-Preventable Diseases) |publisher=Public Health Foundation |location=Washington, D.C |year=2011 |isbn=978-0-01-706609-1 |url=https://www.cdc.gov/vaccines/pubs/pinkbook/downloads/tetanus.pdf |chapter=Tetanus |access-date=4 January 2016 |url-status=live |archive-url=https://web.archive.org/web/20080306134607/http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/tetanus.pdf |archive-date=6 March 2008 }} {{PD-notice}}</ref> Globally, deaths from tetanus in newborns decreased from 787,000 in 1988 to 58,000 in 2010, and 34,000 deaths in 2015 (a 96% decrease from 1988).<ref name=Pink2015/><ref>{{cite web |vauthors = ((World Health Organization)) |author-link = World Health Organization |title=Tetanus |url=https://www.who.int/news-room/fact-sheets/detail/tetanus |website=[[World Health Organization]] (WHO) |date=9 May 2018 |access-date=12 January 2020}}</ref> In the 1940s, before the vaccine, there were about 550 cases of tetanus per year in the United States, which has decreased to about 30 cases per year in the 2000s.<ref name=Pink2015/> Nearly all cases are among those who have never received a vaccine, or adults who have not stayed up to date on their 10-year booster shots.<ref>{{cite web |url=https://www.cdc.gov/tetanus/about/index.html |title=About Tetanus | publisher=[[Centers for Disease Control and Prevention]] (CDC) |access-date=11 December 2014 |url-status=live |archive-url=https://web.archive.org/web/20141111113214/http://www.cdc.gov/tetanus/about/index.html |archive-date=11 November 2014 }} {{PD-notice}}</ref>

===Pregnancy===

Guidelines on [[prenatal care in the United States]] specify that women should receive a dose of the [[Tdap vaccine]] during each pregnancy, preferably between weeks 27 and 36, to allow antibody transfer to the fetus.<ref name=cdctdap>{{cite journal |title=Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) in pregnant women--Advisory Committee on Immunization Practices (ACIP), 2012 |journal=MMWR Morb. Mortal. Wkly. Rep. |volume=62 |issue=7 |pages=131–5 |date=February 2013 |pmid=23425962 |pmc=4604886 |url=https://www.cdc.gov/mmwr/pdf/wk/mm6207.pdf|author1=Centers for Disease Control Prevention (CDC) }} {{PD-notice}}</ref><ref name="pmid31971933" /> All postpartum women who have not previously received the Tdap vaccine are recommended to get it prior to discharge after delivery.<ref name=cdctdap2>{{cite web | title=Pregnancy Guidelines and Recommendations by Vaccine - Tetanus, Diphtheria, and Pertussis (Tdap); & Tetanus and Diphtheria (Td)| website=[[Centers for Disease Control and Prevention]] (CDC) | date=August 2016 | url=https://www.cdc.gov/vaccines/pregnancy/hcp-toolkit/guidelines.html#tdap | access-date=15 January 2020}} {{PD-notice}}</ref> It is recommended for pregnant women who have never received the tetanus vaccine (i.e., neither DTP or DTaP, nor DT as a child or Td or TT as an adult) to receive a series of three Td vaccinations starting during pregnancy to ensure protection against maternal and [[neonatal tetanus]]. In such cases, Tdap is recommended to be substituted for one dose of Td, again preferably between 27 and 36 weeks of gestation, and then the series completed with Td.<ref name=cdctdap /><ref name="pmid31971933">{{cite journal |vauthors=Havers FP, Moro PL, Hunter P, Hariri S, Bernstein H |title=Use of Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis Vaccines: Updated Recommendations of the Advisory Committee on Immunization Practices - United States, 2019 |journal=MMWR Morb. Mortal. Wkly. Rep. |volume=69 |issue=3 |pages=77–83 |date=January 2020 |pmid=31971933 |doi=10.15585/mmwr.mm6903a5 |pmc=7367039 |url=https://www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6903a5-H.pdf }} {{PD-notice}}</ref>

===Specific types ===

The first vaccine is given in infancy. The baby is injected with the [[DTaP]] vaccine, which is three inactive toxins in one injection. DTaP protects against [[diphtheria]], [[pertussis]], and tetanus. This acellular vaccine is safer than the previously used DTP with whole inactivated pertussis (now retroactively notated DTwP<ref name=iran-choice>{{cite journal | vauthors = Syed MA | title = Choosing from Whole Cell and Acellular Pertussis Vaccines-Dilemma for the Developing Countries | journal = Iranian Journal of Public Health | volume = 46 | issue = 2 | pages = 272–273 | date = February 2017 | pmid = 28451568 | pmc = 5402791 }}</ref>).<ref name=CDC2015 /> Another option is DT, which is a combination of diphtheria and tetanus vaccines. This is given as an alternative to infants who have conflicts with the DTaP vaccine.<ref name=VaccInfo2011/> Quadrivalent, pentavalent, and hexavalent formulations contain DTaP with one or more of the additional vaccines: inactivated [[polio]] virus vaccine (IPV), [[Haemophilus influenzae type b]] conjugate, [[Hepatitis B]], with the availability varying in different countries.<ref>{{cite web|url=https://www.cdc.gov/vaccines/schedules/downloads/child/binational-schedule-pr.pdf|title=2016 Binational Immunization Resource Tool for Children from Birth Through 18 Years|publisher=[[Centers for Disease Control and Prevention]] (CDC)|access-date=22 December 2016|url-status=live|archive-url=https://web.archive.org/web/20170211190238/https://www.cdc.gov/vaccines/schedules/downloads/child/binational-schedule-pr.pdf|archive-date=11 February 2017}} {{PD-notice}}</ref><ref>{{cite journal | title = Licensure of a diphtheria and tetanus toxoids and acellular pertussis adsorbed, inactivated poliovirus, and haemophilus B conjugate vaccine and guidance for use in infants and children | journal = MMWR Morb. Mortal. Wkly. Rep. | volume = 57 | issue = 39 | pages = 1079–80 | date = October 2008 | pmid = 18830213 | url = https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5739a5.htm | access-date = 22 December 2016 | url-status = live | archive-url = https://web.archive.org/web/20161107212453/http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5739a5.htm | archive-date = 7 November 2016 | author1 = Centers for Disease Control Prevention (CDC) }} {{PD-notice}}</ref><ref name="pmid24004825">{{cite journal | vauthors = Baldo V, Bonanni P, Castro M, Gabutti G, Franco E, Marchetti F, Prato R, Vitale F | title = Combined hexavalent diphtheria-tetanus-acellular pertussis-hepatitis B-inactivated poliovirus-Haemophilus influenzae type B vaccine; Infanrix™ hexa: twelve years of experience in Italy | journal = Hum Vaccin Immunother | volume = 10 | issue = 1 | pages = 129–37 | date = 2014 | pmid = 24004825 | pmc = 4181021 | doi = 10.4161/hv.26269 }}</ref>

For the every ten-year booster Td or Tdap may be used, though Tdap is more expensive.<ref name="pmid31971933" />

===Schedule===

Because DTaP and DT are administered to children less than a year old, the recommended location for injection is the anterolateral thigh muscle.{{medcn|date=January 2020}} However, these vaccines can be injected into the [[deltoid muscle]] if necessary.{{medcn|date=January 2020}}

The [[World Health Organization]] (WHO) recommends six doses in childhood starting at six weeks of age.<ref name=WHO2017/> Four doses of DTaP are to be given in early childhood.<ref name=VaccInfo2011/> The first dose should be around two months of age, the second at four months, the third at six, and the fourth from fifteen to eighteen months of age. There is a recommended fifth dose to be administered to four- to six-year-olds.<ref name=VaccInfo2011/>

Td and Tdap are for older children, adolescents, and adults and can be injected into the deltoid muscle.<ref name=VaccInfo2011/> These are boosters and are recommended every ten years. It is safe to have shorter intervals between a single dose of Tdap and a dose of the Td booster.<ref name="Reference 2">{{cite book| vauthors = Talbot EA |title=The Safety of Immunizing with Tetanus–diphtheria–acellular Pertussis Vaccine (Tdap) Less than 2 Years following Previous Tetanus Vaccination: Experience during a Mass Vaccination Campaign of Healthcare Personnel during a Respiratory Illness Outbreak|year=2010|pages=8001–7}}</ref>

====Additional doses====

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 [[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.<ref name="Reference 7">{{cite book| vauthors = Veronesi R |title=Tetanus: Important New Concepts|year=1981|publisher=Excerpta Medica|location=Amsterdam}}</ref>

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.<ref name="pmid31971933" />

Tdap is given as a one-time, first-time-only dose that includes the tetanus, diphtheria, and acellular pertussis vaccinations.<ref name=CDC2015 /> This should not be administered to those who are under the age of eleven or over the age of sixty-five.{{medcn|date=January 2020}}

Td is the booster shot given to people over the age of seven and includes the tetanus and diphtheria [[toxoid]]s. However, Td has less of the diphtheria toxoid, which is why the "d" is lowercase and the "T" is capitalized.<ref name=CDC2015 />

In 2020, the US [[Centers for Disease Control and Prevention]] (CDC) [[Advisory Committee on Immunization Practices]] (ACIP) recommended that either tetanus and diphtheria toxoids (Td) vaccine or Tdap to be used for the decennial Td booster, tetanus prevention during wound management, and for additional required doses in the catch-up immunization schedule if a person has received at least one Tdap dose.<ref name="pmid31971933" />

==Side effects==

[[File:Tetanusimpfung - Tag danach Crop.jpg|thumb|A bump resulting from a tetanus vaccine injection]]

Common side effects of the tetanus vaccine include fever, redness, and swelling with soreness or tenderness around the injection site (one in five people have redness or swelling). Body aches and tiredness have been reported following Tdap. Td / Tdap can cause painful swelling of the entire arm in one of 500 people.<ref name=VaccInfo2011/><ref>{{cite web | title=Tdap (Tetanus, Diphtheria, Pertussis) Vaccine Information Statement | website=U.S. [[Centers for Disease Control and Prevention]] (CDC) | date=August 2021 | url=https://www.cdc.gov/vaccines/hcp/vis/vis-statements/tdap.html | archive-url=https://web.archive.org/web/20191228213722/https://www.cdc.gov/vaccines/hcp/vis/vis-statements/tdap.html | archive-date=28 December 2019 | url-status=live | access-date=28 December 2019 }} {{PD-notice}}</ref>

Tetanus toxoid containing vaccines (DTaP, DTP, Tdap, Td, DT) may cause [[brachial neuritis]] at a rate of one out of every 100,000 to 200,000 doses.<ref name=Pink2015 /><ref>{{cite journal |title=Update: vaccine side effects, adverse reactions, contraindications, and precautions. Recommendations of the Advisory Committee on Immunization Practices (ACIP) |journal=MMWR Recomm Rep |volume=45 |issue=RR-12 |pages=1–35 |date=September 1996 |pmid=8801442 |url=<!-- Official URL --> https://www.cdc.gov/mmwr/PDF/rr/rr4512.pdf }} {{PD-notice}}</ref>

==Mechanism of action==

The type of vaccination for this disease is called artificial [[active immunity]]. This type of [[immunity (medical)|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 because it means that if the disease is ever introduced into the body, the [[immune system]] will recognize the [[antigen]] and produce antibodies more rapidly.<ref name=CDC>{{cite web|title=Vaccines & Immunizations|url=https://www.cdc.gov/vaccines/vac-gen/immunity-types.htm|access-date=27 November 2011| publisher=U.S. [[Centers for Disease Control and Prevention]] (CDC) | url-status=live|archive-url=https://web.archive.org/web/20111222052748/http://cdc.gov/vaccines/vac-gen/immunity-types.htm|archive-date=22 December 2011}} {{PD-notice}}</ref>

==History==

The first vaccine for passive immunology was discovered by a group of German scientists under the leadership of [[Emil von Behring]] in 1890.

The first inactive [[tetanus toxoid]] was discovered and produced in 1924. A more effective [[Adsorption|adsorbed]] version of the vaccine, created in 1938, was proven to be successful when it was used to prevent tetanus in the military during [[World War II]].<ref name=VaccInfo2011/> [[DPT vaccine|DTP/DTwP]] (which is the combined vaccine for [[diphtheria]], tetanus, and [[pertussis]]) was first used in 1948, and was continued until 1991, when it was replaced with an acellular form of the pertussis vaccine due to safety concerns.<ref>{{cite web |url=https://www.historyofvaccines.org/timeline#EVT_100746 |title=Whooping Cough: Vaccine Combined with Tetanus, Diphtheria |author=<!-- Not stated --> |access-date=1 May 2017 |url-status=live |archive-url=https://web.archive.org/web/20170606213421/https://www.historyofvaccines.org/timeline#EVT_100746 |archive-date=6 June 2017 }}</ref> Half of those who received the DT(w)P vaccine had redness, swelling, and pain around the injection site,<ref name=VaccInfo2011/> 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).<ref name=VaccInfo2011/>

==Further reading==

{{refbegin|30em}}

* {{cite journal |vauthors=Liang JL, Tiwari T, Moro P, Messonnier NE, Reingold A, Sawyer M, Clark TA |title=Prevention of Pertussis, Tetanus, and Diphtheria with Vaccines in the United States: Recommendations of the Advisory Committee on Immunization Practices (ACIP) |journal=MMWR Recomm Rep |volume=67 |issue=2 |pages=1–44 |date=April 2018 |pmid=29702631 |pmc=5919600 |doi=10.15585/mmwr.rr6702a1 |url=https://www.cdc.gov/mmwr/volumes/67/rr/pdfs/rr6702a1-H.pdf | issn=1057-5987 }}

* {{cite journal |vauthors=Kahn KE, Black CL, Ding H, Williams WW, Lu PJ, Fiebelkorn AP, Havers F, D'Angelo DV, Ball S, Fink RV, Devlin R |title=Influenza and Tdap Vaccination Coverage Among Pregnant Women - United States, April 2018 |journal=MMWR Morb. Mortal. Wkly. Rep. |volume=67 |issue=38 |pages=1055–1059 |date=September 2018 |pmid=30260946 |pmc=6188122 |doi=10.15585/mmwr.mm6738a3 |url=https://www.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6738a3-H.pdf }}

* {{cite book | vauthors=((World Health Organization)) | title=The immunological basis for immunization series: module 3: tetanus: update 2018 | publisher=[[World Health Organization]] (WHO) | year=2018 | hdl=10665/275340 | isbn=9789241513616 | id=License: CC BY-NC-SA 3.0 IGO | hdl-access = free }}

* {{cite book | title=Immunisation against infectious disease | chapter=Chapter 30: Tetanus | date=21 January 2021 | chapter-url=https://www.gov.uk/government/publications/tetanus-the-green-book-chapter-30 | publisher=Public Health England | veditors = Ramsay M | url=https://www.gov.uk/government/collections/immunisation-against-infectious-disease-the-green-book }}

* {{cite book | publisher = U.S. [[Centers for Disease Control and Prevention]] (CDC) | title = Epidemiology and Prevention of Vaccine-Preventable Diseases | veditors = Hall E, Wodi AP, Hamborsky J, Morelli V, Schillie S | edition = 14th | location = Washington D.C. | year = 2021 | chapter = Chapter 21: Tetanus | chapter-url = https://www.cdc.gov/vaccines/pubs/pinkbook/tetanus.html | url=https://www.cdc.gov/vaccines/pubs/pinkbook/index.html }}

* {{cite book | chapter = Chapter 16: Tetanus | chapter-url = https://www.cdc.gov/vaccines/pubs/surv-manual/chpt16-tetanus.html | veditors = Roush SW, Baldy LM, Hall MA | title = Manual for the surveillance of vaccine-preventable diseases | publisher = U.S. [[Centers for Disease Control and Prevention]] (CDC) | location = Atlanta GA | url = https://www.cdc.gov/vaccines/pubs/surv-manual/ | date=March 2019 }}

{{refend}}

==External links==

{{Commons category|Tetanus vaccination}}

* {{cite web | title=Td (Tetanus, Diphtheria) Vaccine Information Statement | website=U.S. [[Centers for Disease Control and Prevention]] (CDC)| date=August 2021| url=https://www.cdc.gov/vaccines/hcp/vis/vis-statements/td.html }}

* {{cite web | title=DTaP (Diphtheria, Tetanus, Pertussis) Vaccine Information Statement | website=U.S. [[Centers for Disease Control and Prevention]] (CDC) | date=August 2021 | url=https://www.cdc.gov/vaccines/hcp/vis/vis-statements/dtap.html }}

* {{cite web | title=DTaP/Tdap/Td ACIP Vaccine Recommendations | website=[[Centers for Disease Control and Prevention]] (CDC) | date=28 January 2020 | url=https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/dtap.html }}

* {{cite web | url = https://druginfo.nlm.nih.gov/drugportal/name/tetanus%20vaccine | publisher = U.S. National Library of Medicine | work = Drug Information Portal | title = Tetanus Vaccine }}

* {{MeshName|Tetanus Toxoid}}

* {{MeshName|Diphtheria-Tetanus Vaccine}}

* {{MeshName|Diphtheria-Tetanus-Pertussis Vaccine}}

* {{MeshName|Diphtheria-Tetanus-acellular Pertussis Vaccines}}

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