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Vaccine Preventable Disease Control
County of Los Angeles
Department of Public Health
Vaccine Preventable Disease Control Program
3530 Wilshire Blvd. Suite 700
Los Angeles, CA 90010
Phone: (213) 351-7800
Email: ip@ph.lacounty.gov
Symptoms:
If you think you may have these symptoms, talk with your doctor or healthcare provider.
Complications:Tetanus infection is dangerous and can lead to serious health complications, including:
Those more likely to have serious complications from tetanus are:
Tetanus does not spread from person to person.
The bacteria that causes tetanus can be found in soil, dust, manure, and other parts of the environment. It can get into the body by infecting cuts/sores on the skin, animal bites, and burns.
Some of the common ways people are infected with tetanus bacteria include:
To help prevent tetanus, immediately clean and apply first aid to all cuts, scrapes, or other breaks in the skin and wash your hands often with soap and water.
If you think you have been exposed to tetanus bacteria and have not been vaccinated, immediately seek emergency care.
The best way to protect against Tetanus is to get vaccinated. Tetanus shots are safe and effective at preventing severe infection.
The tetanus vaccine series, including booster doses, is nearly 100% effective in preventing tetanus. Nearly all cases of tetanus today are in people who never got a tetanus vaccine or did not receive a complete course of tetanus vaccines, or adults who didn't stay up to date on their 10-year booster shots.
There are three kinds of vaccines used in the United States today to help protect against tetanus. They also protect against diphtheria and whooping cough (pertussis).
You should not get a tetanus-containing vaccine if you:
There are many places to get the tetanus vaccine. If you have insurance, talk to your doctor or check with your local pharmacy to see what vaccines are offered. Most health insurances cover the cost of all recommended vaccines for children and adults.
If you are uninsured or underinsured, there are programs available to help cover the cost of vaccines. Children who are 18 years of age or younger are eligible to receive vaccines at no cost through the Vaccines for Children (VFC) Program if they are:
Click to see if your child is eligible to receive VFC vaccines: English | Spanish
Uninsured or underinsured adults can access free or low cost vaccines at select clinics enrolled in the Vaccines for Adults (VFA) program. For more information on who is eligible, read VFA Eligibility Based on Insurance Status. You can use the following resources for more information on locating clinics:
You can also dial 2-1-1 for a list of free or low cost vaccine clinics. This includes Vaccines for Children (VFC) provider locations that serve Medi-Cal eligible children and uninsured or underinsured adults. Learn more about specific vaccine information for different age groups:
Are you not sure if you have been vaccinated against tetanus or you can’t find your vaccine records?
If you need official copies of your vaccine records, or if you need to update your personal records:
Tetanus symptoms traditionally present as uncontrollable and painful muscle contractions, which can take the form of seizures or severe musculoskeletal cramping that contorts the body. It can present in different clinical forms: Generalized, localized or neonatal. Generalized presentation of tetanus begins in the masseter and neck muscles, causing trismus (commonly known as “lockjaw”). Due to the anatomical structure within the neck, tetanus-caused trismus is often accompanied by difficulty swallowing, head jerking or staring, headaches, and fever. It can cause autonomic overactivity with sweating and tachycardia, profuse sweating and cardiac arrhythmias, and airway compromise. During generalized spasms, patients clench their fists, arch their back and abduct their arms. Spasms can be intensely painful.
Localized tetanus is a result of a cut or a wound that is exposed to tetanus spores. In localized cases, the muscle contraction may be confined to the region of the injury. Neonatal tetanus is a form of generalized tetanus affecting newborn infants born to an unimmunized mother. Neonatal tetanus is usually the result of unsterile equipment used during the cutting of the umbilical stump and symptoms develop 5-7 days after birth. Neonates will refuse their feed and have difficulty crying, and then will proceed to have rigidity and spasms of their trunk.
Tetanus is not communicable from person-to-person, and therefore isolation for cases and quarantine for contacts is not necessary.
Diagnosis of tetanus is clinical. Healthcare providers diagnose tetanus by looking for and observing clinical signs and symptoms.
C. Tetani bacteria may be recovered from the wound site of a clinically diagnosed tetanus infection, but it has historically only been collected in 30% of cases. Culture results have shown to be unreliable in tetanus diagnostic confirmation, as false-positive and false-negative results are common. Laboratory identification of the organism depends primarily on the demonstration of toxin production in mice.
If collected, specimen should be stored using common bacterial transport media.
DTaP (diphtheria, tetanus, and acellular pertussis), Td (tetanus, diphtheria), and Tdap (tetanus, diphtheria, and acellular pertussis) vaccines all protect against tetanus.
The CDC recommends the tetanus vaccination series as follows:
Catch – Up Guidance for Children 4 Months through 18 Years
Guidance for Td
Rates of tetanus are currently at a historical low in the United States. Vaccine trials have not previously included tetanus toxoid efficacy, but experts can infer efficacy from protective antitoxin levels. A complete vaccination series likely has a clinical efficacy of virtually 100% for tetanus. A complete series of tetanus vaccination is 4 doses for children younger than 7 years old and 3 doses for people 7 years old or older.
| Tetanus Toxoid-containing Vaccines and Brands |
Doses | Age | Dose/Route |
|---|---|---|---|
| Daptacel (DTaP) Sanofi Pasteur |
5 | 2, 4, 6, & 15-18 months; Booster dose at 4-6 years |
0.5mL Intramuscular (IM) |
| Infanrix (DTaP) Sanofi Pasteur |
5 | 2, 4, 6, & 15-18 months; Booster dose at 4-6 years |
0.5mL Intramuscular (IM) |
| Pediarix (DTap-HepB-IPV) GlaxoSmithKline |
3 | 2, 4, & 6 months | 0.5mL Intramuscular (IM) |
| Pentacel (DTaP-IPV/Hib) Sanofi Pasteur |
4 | 2, 4, 6, & 15-18 months | 0.5mL Intramuscular (IM) |
| VAXELIS (DTaP-IPV-Hib-HepB)β MSP Vaccine Company |
3 | 2, 4 & 6 months | 0.5mL Intramuscular (IM) |
| Kinrix (DTaP-IPV)** GlaxoSmithKline |
1 | 4-6 years | 0.5mL Intramuscular (IM) |
| Quadracel (DTap-IPV)*** Sanofi Pasteur |
1 | 4-6 years | 0.5mL Intramuscular (IM) |
| Adacel (Tdap)+ Sanofi Pasteur |
>1 | ≥7 years, Recommended at 11-12 years; Booster dose every 10 years |
0.5mL Intramuscular (IM) |
| Boostrix (TdaP)+ GlaxoSmithKline (GSK) |
>1 | ≥7 years, Recommended at 11-12 years; Booster dose every 10 years |
0.5mL Intramuscular (IM) |
| TENIVAC (Td) Sanofi Pasteur |
>1 | ≥7 years; Booster dose every 10 years |
0.5mL Intramuscular (IM) |
*Tetanus–containing vaccines can be co-administered with other vaccines.
*ACIP prefers that, whenever feasible, the doses of vaccine in a series come from the same manufacturer.
**Kinrix is approved only for dose 5 of DTaP and dose 4 of IPV.
***Quadracel is approved only for dose 5 of DTaP and dose 4 or 5 of IPV.
+Either Tdap vaccine administered to a person aged 65 years or older is immunogenic and would provide protection. A dose of either vaccine would be considered valid.
βPreferred for use in American Indian and Alaska Native infants based on the Haemophilus influnzae type B component.
Proper vaccine storage and handling practices play an important role. For general recommendations and guidance access the Vaccine Storage and Handling Toolkit.
Please contact the LAC DPH Vaccine-Preventable Disease Control Program to report a case, obtain technical assistance with specimen collection or completion of forms for tetanus. Suspected tetanus cases are to be reported within 7 calendar days from identification, by telephone, electronic transmission (email or digital fax), or mail (IAW Title 17, California Code of Regulations (CCR), Section 2500).
Click here for more information on reporting a Vaccine Adverse Event.
Tetanus immune globulin (TIG) is recommended as treatment for persons with tetanus infection. TIG can help to remove unbound tetanus toxin but cannot affect toxin already bound to nerve endings.
Intravenous immune globulin (IVIG) contains tetanus antitoxin and may be used if TIG is not available.
Medical management of tetanus should prioritize wound cleaning, through removal of all foreign material and necrotic tissue. If the patient is experiencing tetanic spasms, maintenance of an adequate airway is critical.
Immunization with tetanus toxoid should occur only after the person’s condition is stable.
Routine Wound Management Guide for Tetanus Prophylaxis with TIG (CDC Pink Book – Tetanus)
| History of absorbed tetanus toxoid-containing vaccines | ||
|---|---|---|
| Wound Classification (Treatment) | Unknown or <3 doses | >=3 doses |
| Clean, minor wounds (DTap, Tdap or Td) | Yes | No* |
| All other wounds (DTaP, Tdap, Td) | Yes | No** |
| Clean, minor wounds (TIG) | No | No |
| All other wounds (TIG)*** | Yes | No |
*Yes, if ≥10 years since the last tetanus toxoid-containing vaccine dose.
**Yes, if ≥ 5 years since the last tetanus toxoid-containing vaccine dose.
***People with severe immunodeficiency or HIV infection, who have contaminated wounds, should also receive TIG, regardless of tetanus immunization history.
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Public Health has made reasonable efforts to provide accurate translation. However, no computerized translation is perfect and is not intended to replace traditional translation methods. If questions arise concerning the accuracy of the information, please refer to the English edition of the website, which is the official version.
