Tetanus Toxoid

What is Tetanus Toxoid

Tetanus toxoid is used to provide active immunity against tetanus. As acquired immunity to tetanus toxin does not occur in the U.S., primary vaccination and booster vaccination with tetanus toxoid are required to protect persons of all age groups.

Immunization with tetanus toxoid is effective in producing serum antitoxin concentrations for at least 10 years.

Tetanus toxoid is currently recommended for primary or booster immunization for all infants 6—8 weeks of age and older, all children, and all adults.

In children <7 years old, tetanus toxoid is usually administered as the trivalent diphtheria and tetanus toxoids and pertussis vaccine adsorbed (DTP) or as diphtheria and tetanus toxoids for pediatric use (DT).

The combination of tetanus and diphtheria toxoids (Td) for adult use is recommended in older children and adults.

The single-agent formulation of tetanus toxoid is available as tetanus toxoid fluid (TT) or tetanus toxoid adsorbed (TTA) to aluminum hydroxide, aluminum phosphate, or potassium alum.

Tetanus toxoid fluid and TTA are mostly used in emergency situations and in patients who have a contraindication to combined antigens. Because of greater antigenic effects, TTA is the preferred single-agent formulation.

Tetanus toxoid fluid is the formulation of choice in patients who are hypersensitive to the aluminum adjuvant in TTA, and it is also used to demonstrate delayed-hypersensitivity reactions in HIV-seropositive patients.

Tetanus toxoid is not for treating an active tetanus infection, which should be treated by administering tetanus immune globulin (see Tetanus Immune Globulin monograph).

Tetanus toxoid should, however, be administered once the infection is adequately treated.

A peripheral benefit of vaccination against tetanus may be a reduction in the risk for multiple sclerosis (MS) development.

Patients with a history of tetanus vaccination had an odds of developing either MS or optic neuritis of 0.6 (95% CI, 0.4—0.8) the odds of disease development in nonvaccinated patients.

Further, combined data from 9 case-control studies yielded a similar OR of 0.67 (95% CI, 0.55—0.81) for MS and tetanus vaccination.


  • tetanus prophylaxis

Side Effects

  1. anaphylactic shock
  2. anaphylactoid reactions
  3. angioedema
  4. arthralgia
  5. Arthus reaction
  6. dyspnea
  7. EEG changes
  8. encephalopathy
  9. erythema
  10. fever
  11. Guillain-Barre syndrome
  12. hypotension
  13. injection site reaction
  14. malaise
  15. myalgia
  16. nausea
  17. neuritis
  18. rash
  19. urticaria

Monitoring Parameters

  • laboratory monitoring not necessary


  • anticoagulant therapy
  • breast-feeding
  • coagulopathy
  • hemophilia
  • immunosuppression
  • neurological disease
  • pregnancy
  • radiation therapy
  • seizures
  • thimerosal hypersensitivity
  • thrombocytopenia
  • vitamin K deficiency


  • Adalimumab
  • Fingolimod
  • Ocrelizumab
  • Rh0 [D] Immune Globulin
  • Siponimod

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