What is tetanus vaccination?
Tetanus is caused by the bacterium Clostridium tetani, or more precisely by its toxin. The pathogen enters the human body through small or large wounds and produces two toxins (bacterial poisons). One of these, tetano-spasmin, is responsible for the typical symptoms of tetanus. The real danger is therefore not the bacteria themselves, but their tetanus toxin.
The active tetanus vaccine
This is precisely where the active tetanus vaccine comes in. In principle, it is the bacterial toxin itself, but in a weakened form. Physicians then speak of the tetanus toxoid. If the patient is injected with it in this state, his immune system comes into contact with the “light version” of the toxin and begins to form antibodies against it.
However, because the injected toxin is attenuated (“detoxified”), it does not cause disease. Rather, the tetanus vaccine elicits effective immune protection against the infectious disease. Should an actual infection with the dangerous pathogen occur later, the immune system reacts more quickly and fights off the toxins of the tetanus pathogen in particular. The vaccinated person is therefore immune to the tetanus disease and, as a rule, no longer falls ill.
The vaccination against tetanus contains the “detoxified” pathogen toxin (toxoid), which is why it is also called a toxoid vaccine.
The passive tetanus vaccination
In contrast to active vaccinations, in passive vaccinations the doctor injects ready-made antibodies that are directed against the tetano-spasmin. These so-called tetanus immunoglobulins (tetanus antitoxin) are obtained from human blood. They are used when the patient has an open injury but there is no active vaccination. If affected individuals then receive the passive tetanus vaccine, this usually prevents or at least significantly attenuates the symptoms of tetanus.
Any tetanus vaccine, whether passive or active, is injected into a muscle (intramuscularly, i.m.), either on the upper arm or thigh. In addition, for an open wound, doctors give the passive tetanus immunization into the muscles at the edges of the wound.
What are the side effects?
As with many other medicines, they exist with tetanus immunization: side effects. However, these are rather rare and harmless in the vast majority of cases. The most common side effects include:
- Temporary discomfort in the gastrointestinal tract (nausea, diarrhea)
- Headache
- Fever
- swelling, redness, and pain at the injection site
As is actually the case with all vaccinations, one should not undertake any great physical exertion immediately after a tetanus vaccination, i.e. at least not do any heavy physical work on the same day, do no sports and possibly also avoid alcohol on the day of vaccination. A vaccination always puts a certain amount of strain on the body.
Tetanus vaccination during pregnancy and breastfeeding
Tetanus vaccination during pregnancy is considered by experts to be safe – both for the mother and for the unborn child. If the mother has not yet received basic immunization, experts from the World Health Organization (WHO) even recommend vaccination as early as possible in pregnancy with three doses at intervals of two and six months.
Medical experts also see no obstacles to tetanus vaccination during breastfeeding.
How should one be vaccinated?
The Standing Committee on Vaccination (STIKO) explicitly recommends active tetanus vaccination for people of all ages. In principle, vaccination is possible at any time, with the exception of serious illnesses and high fever. This is because under these circumstances the immune system is weakened, or already so busy that it may not build up sufficient immune protection against the tetanus toxin. However, a mild cold is not an obstacle to vaccination, as is often wrongly assumed.
The first step is the so-called basic immunization. It begins in early infancy. The tetanus vaccination is usually administered by the doctor together with other standard vaccinations against diphtheria, polio, pertussis, hepatitis B and Haemophilus influenzae type b (Hib). For this so-called six-fold vaccination, the STIKO experts currently recommend a 2+1 vaccination schedule – as a total of three vaccination doses:
- From the second month of life, doctors inject the first tetanus vaccination (or sixfold vaccination).
- At four months of age, children receive the second vaccine dose.
- At eleven months of age, basic immunization ends with the third tetanus vaccination.
Not all vaccines are licensed for the reduced 2+1 vaccination schedule. If only those are available, doctors administer the vaccine four times (in months two, three, four, and eleven of life)!
Premature infants (born before 37 weeks of gestation) always receive four tetanus vaccinations (3+1 vaccination schedule). In addition to the above vaccination dates, the doctor injects the tetanus vaccine an additional time in the third month of life – also as part of a six-vaccination schedule.
Tetanus booster vaccination
A tetanus infection that has been passed through does not confer lasting immune protection! The tetanus vaccination is therefore still important for people who have already had tetanus.
Don’t forget a booster!
Although the basic immunization leads to the formation of antibodies, it must be refreshed at regular intervals. If the tetanus vaccination was given in infancy, the vaccination protection is refreshed with one injection each in the fifth to sixth year of life and between the ninth and 16th year of life. To maintain vaccine protection, adults must also get revaccinated every ten years thereafter.
Diphtheria, whooping cough and tetanus: booster vaccination in a collective package
The booster in the fifth year of life is given in combination with the diphtheria vaccination and pertussis vaccination. The next booster for adolescents is administered by doctors as a quadruple vaccination against tetanus, diphtheria, polio and pertussis.
For adults, the combined tetanus-diphtheria vaccination (Td vaccination) is best for booster protection every ten years. However, STIKO experts advise that adults receive the triple combination vaccine against tetanus, diphtheria and pertussis (Tdap vaccination) once.
Is a tetanus vaccination really useful?
Common worldwide, tetanus is rather rare in Germany. The reasons for this are sometimes the good living conditions and hygienic conditions, but above all a high tetanus vaccination rate. But even in this country, despite the good medical care, there are still deaths. However, the number of cases has continued to decline as vaccination has become more widespread – by way of comparison, there were well over 100 cases of tetanus before 1970. Because the pathogen is found almost everywhere, tetanus vaccination remains the only way to effectively protect against infection.
Tetanus vaccination for injuries
How doctors vaccinate for a wound depends, on the one hand, on the vaccination status of the affected person. On the other hand, the wound conditions play a role. For clean and small injuries, the following applies:
- Individuals without tetanus vaccination or with unclear vaccination status: tetanus simultaneous vaccination, i.e., vaccination with both an active tetanus vaccine and passive immunization
- Individuals with incomplete vaccination series or last tetanus booster vaccination over ten years ago: active immunization only
- Individuals with at least three vaccine doses or a booster within the past ten years: no tetanus vaccination required
- Persons without tetanus vaccination, with unclear vaccination status or less than three previous vaccination doses: Simultaneous vaccination (active + passive tetanus vaccination).
- Persons with at least three vaccinations and one booster within the last five years: no vaccination required
- Individuals with at least three vaccinations and one booster given more than five years ago: active tetanus vaccination
In simultaneous vaccination, doctors inject the passive and active immunizations into different muscles. Tetanus vaccines are given in the form of combination vaccines.
