Tetanus vaccines are based on tetanus toxoid. The manufacturing process of conventional vaccine comprises the cultivation of toxigenic strains of C. tetani in a liquid medium that favors the production of the toxin, the extraction of the toxin by filtration, its detoxification with formaldehyde and several stages of purification and sterilization. To increase its immunogenicity, the toxoid is adsorbed on aluminum or calcium salts. Tetanus toxoid adsorbed is given by intramuscular injection. Tetanus toxoid is stable and can withstand exposure to a temperature of approximately 20° C for months and storage at 37° C for a few weeks without experiencing a significant loss of potency. However, if it is exposed to a temperature of 56 °C, the vaccine is destroyed within two hours.
What Happens If you Get a Tetanus Shot Too Soon?
While immunized people should be adequately protected against tetanus, doctors who treat patients with wounds can give them a dose of a tetanus toxoid vaccine, in addition to other preventive measures. Depending on the severity of the wound and the reliability of the information on previous tetanus vaccinations, the vaccine should be administered if it has been more than 10 years since the patient received the last dose (5 years if the wounds are severe).
People who have not received all the doses of the basic vaccination schedule should complete it as soon as possible.
In addition, prophylaxis (e.g., in the case of persons not fully immunized with dirty wounds) could require passive immunization of the patient by administration of tetanus antitoxin, preferably of human origin. This antitoxin is also essential in the treatment of tetanus cases and should be readily available in all countries.
Tetanus booster doses can elicit immune responses even after 25 to 30 years from the previous dose, demonstrating the persistence of immune memory.
In case of needing an “extra tetanus booster” due to an acute injury such as a deep cut or puncture wound, it is normally OK to receive it, no consequences have been reported.
Vaccines for use in large-scale public health interventions should meet current WHO quality requirements; be innocuous and produce a significant effect against the disease itself in all target population groups; if they are intended for infants or young children, adapt easily to the schedules and deadlines set by national childhood immunization programs; not interfere significantly with the immune response to other vaccines administered simultaneously; be formulated in such a way that they meet common technical limitations, for example in terms of refrigeration capacity and storage; and have adequate prices for different markets.
Tetanus toxoid satisfactorily meets all the aforementioned WHO general requirements. It is easy to obtain worldwide, both in the form of an independent antigen and as part of combined vaccines.
The main objectives of the fight against tetanus are 1) eliminate tetanus worldwide, and 2) achieve and maintain high vaccination coverage with DTP and the relevant booster doses to prevent tetanus in all age groups.
Efficacy and Effectiveness of Vaccines
Although the protection is incomplete after the first dose of the vaccine, after the second dose protective concentrations of antitoxin are reached in most of the vaccinated, and a third dose induces immunity in almost 100% of the vaccinated.
The interval between doses of tetanus toxoid vaccines should be at least four weeks. Prolonging the intervals between doses may increase the magnitude and duration of the immune response, but this does not mean that vaccination should be delayed.
Both the efficacy and effectiveness of tetanus toxoid are well documented. Most clinical studies have reported efficiencies of between 80% and 100%.
Duration of Protection
The concentration and avidity of the antibodies, as well as the duration of protection, depending on several factors, such as the age of the vaccinated, the number of doses of the vaccine and the intervals between the doses. The administration of three doses of DTP during the breastfeeding period will provide 3 to 5 years of protection, an additional or booster dose (e.g., in the early years of childhood) will provide protection until adolescence, and one or two additional booster doses will induce immunity well into adulthood (it has been suggested that the duration may be 20 to 30 years).
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