Immunization, Vaccines and Biologicals

Tetanus

Tetanus is a non-communicable disease contracted through exposure to the spores of the bacterium, Clostridium tetani, that exists worldwide in soil and in animal intestinal tracts, and as such can contaminate many surfaces and substances. As a result of the ubiquity of the bacterium causing tetanus, the disease cannot be eradicated. Neurotoxins produced under anaerobic conditions in wounds contaminated with the bacterial spores lead to tetanus. Tetanus occurring during pregnancy or within 6 weeks of the end of pregnancy is called “maternal tetanus”, while tetanus occurring within the first 28 days of life is called “neonatal tetanus”.

People of all ages can get tetanus but the disease is particularly common and serious in newborn babies and their mothers when the mothers` are unprotected from tetanus by the vaccine, tetanus toxoid. Tetanus requires treatment in a medical facility, often in a referral hospital. Neonatal tetanus, which is mostly fatal, is particularly common in difficult to reach and rural areas where deliveries take place at home without adequate sterile procedures and in unclean environment. WHO estimated that neonatal tetanus killed about 30,848 newborn children in 2017, a 96% reduction from the situation in 1988 when an estimated 787,000 newborn babies died of tetanus within their first month of life.

Tetanus can be prevented through immunization with tetanus-toxoid-containing vaccines (TTCV). WHO recommends the use of combination vaccines containing diphtheria toxoid as well, for example Td. Neonatal tetanus can be prevented by immunizing women of reproductive age with TTCV, either during pregnancy or outside of pregnancy. This protects the mother and - through a transfer of tetanus antibodies to the fetus - also her baby. Additionally, clean practices when a mother is delivering a child are also important to prevent neonatal and maternal tetanus.

People who recover from tetanus do not have natural immunity and can be infected again and therefore need to be immunized. To be protected throughout life, WHO recommends that an individual receives 6 doses (3 primary plus 3 booster doses) of TTCV through routine immunization.

WHO recommends a 3-dose primary vaccination series with tetanus-diphtheria containing vaccine followed by 3 booster doses. The 3-dose primary series should begin as early as 6 weeks of age, with subsequent doses given with a minimum interval of 4 weeks between doses. The 3 booster doses should preferably be given during the second year of life (12-23 months), at 4-7 years, and at 9-15 years of age. Ideally, there should be at least 4 years between booster doses.

Worldwide, all countries are committed to "elimination" of maternal and neonatal tetanus (MNT), i.e. a reduction of neonatal tetanus incidence to below one case per 1000 live births per year in every district. As of March 2019, 13 countries remain that have not eliminated MNT.

WHO position papers

Disease burden and surveillance

Vaccine topics

Further information

Last updated: 29 April 2019

NEW!

Protecting All Against Tetanus:

Guide to sustaining maternal and neonatal tetanus elimination (MNTE) and broadening tetanus protection for all populations

July 2018

Replacement of TT with Td vaccine

WHO and UNICEF strongly urge countries to take the necessary steps to implement the long-standing WHO recommendation to replace TT with Td vaccine to ensure sustained protection against both diphtheria and tetanus.

WHO/UNICEF Joint Communique - Replacement of TT with Td vaccine for dual protection

WHO/UNICEF Guidance Note - Ensuring Sustained Protection Against Diphtheria: Replacing TT with Td vaccine

Frequently Asked Questions and Answers - Replacement of TT with Td