“My child had a fall, should he/she be given tetanus vaccination?” That’s the typical question parents pose to paediatricians. These concerns need to be addressed by figuring out the place of the fall and if the child came in contact with soil, mud or a rusted material, says Dr JK Reddy, paediatrician and neonatologist, Apollo Children’s Hospital, Chennai.
Tetanus is a severe infection caused by the bacteria Clostridium tetani, that lives in the soil. A neurotoxin called tetanospasmin released by the bacteria affects the nervous system. The disease is characterised by muscle spasms, lockjaw, stiffness, etc.
According to the vaccination guidelines of Indian Academy of Pediatrics (IAP), there are six scheduled doses of tetanus vaccine (including three initial and booster doses each). Dr Reddy explains the vaccination schedule for a baby:
- The three initial doses should be administered at the sixth, tenth and fourteenth week.
- The three booster doses should be administered at one and a half, five and ten years old.
If a person who received the tetanus vaccination more than five years ago encounters a fall, he/she should receive another dose of the vaccine, says Dr Reddy.
“However, if a child is vaccinated at the fifth year and encounters a fall at the seventh year, there’s no need to repeat the dose,” he adds. He laments that most parents forget about the tetanus vaccine once their children cross five years.
“If you have taken the tetanus vaccine, it is valid for ten years,” says Dr Kamal Bhalla, senior consultant, Sagar Hospitals, Bengaluru. “In case of a dirty wound, we recommend another dose of the vaccine if five years have passed since the last dose,” she adds.
Need for a vaccine: type of wound, vaccination history matter
While considering a dose of tetanus vaccine, the doctors first check if the wound is dirty or clean, which Dr Bhalla explains here:
- A dirty wound refers to an outdoor injury, which can be due to an accident, a fall on the playground, a thorn injury or anything involving mud and soil particles. Tetanus bacteria can proliferate in the mud, soil or thorns.
- A clean wound refers to a sterile wound such as a knife injury (without rust) or falling at home. In case of clean wounds, the vaccine does not need to be repeated. However, if the sharp object is rusted, then the vaccine should be administered.
For adults, a booster dose of the vaccine is recommended once in every ten years. Besides, a booster dose is also given during pregnancy.
“However, vaccination records are unfortunately not generally maintained among adults like the way it is maintained in a child’s vaccination report. Hence, when a person says that he/she received the vaccination five or ten years ago, it’s only an approximation,” says Dr Bhalla.
Tetanus vaccine for dog bites
The tetanus vaccine is also given in case of dog bites, said Dr Bhalla. She recalled treating a 35-year-old man from Bengaluru who had suffered a dog bite. “The man was given a tetanus injection along with anti-rabies vaccination. Tetanus vaccine is given as suffering a dog bite may result in a fall in the mud, which is considered to be a dirty wound,” said Dr Bhalla.
Incidents of tetanus infection are very rare, largely because of the awareness about the tetanus vaccine, says Dr Bhalla, adding that the last case of tetanus infection she came across was more than a decade ago. If anyone has been infected by tetanus, the typical symptoms will be muscle stiffness, muscle spasms resulting in arching of the spine, lockjaw (which causes a person’s neck and jaw muscles to lock, making it hard to open the mouth or swallow) and whole-body jerk.
Tetanus immunoglobulin
In some cases, doctors also advise tetanus immunoglobulin. “If someone gets a bad wound accompanied by a high fever following an injury or fall, leading to a strong suspicion of Clostridium tetani exposure, then tetanus immunoglobulin must be given immediately,” says Dr Reddy. While the tetanus vaccine will provide efficacy in the long term, the immunoglobulin provides protection immediately, he added.
Difference between tetanus immunoglobulin and tetanus vaccine, as explained by Dr Bhalla:
| Tetanus immunoglobulin | Tetanus vaccine |
| It provides readymade antibodies against tetanus bacteria and toxin. | It predisposes the person to the infection, so that the body starts producing antibodies. |
| It provides passive immunity which means that the readymade antibodies will not last long (three to four weeks). | It is an active immunisation to stimulate the body into producing its own antibodies. |
| It is given in case of a bad wound with likely exposure to the bacteria through soil, dirt or mud. | It is given to prevent tetanus infection. |
| It is not given routinely and is used for those with big wounds and suspected excessive bacteria exposure. In addition, it is also given to those who have a compromised immunity (like those suffering from cancer, HIV, advanced disease, those who have undergone organ transplant or are on immunosuppressants). | Apart from routine immunisation, booster doses are also given. For adults, it is recommended once in ten years. It is given in case of an injury where there may be possible exposure to the bacteria. |
| It provides short-term immunity (three to four weeks). | It provides long-term immunity (five to ten years). |
Takeaways
- Three initial and three booster doses of the tetanus vaccine should be given to a newborn child at specified intervals.
- A doctor should be consulted in case of a fall or an injury.
- For adults, a booster dose of the vaccine is recommended once in every ten years.
- Keeping a record of the vaccination is a must.
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