The World Health organization has recommended childhood immunization with Teatuns vaccine (or TT containing vaccines) with a 5 doses schedule [1]. This included a 3 doses in infancy as DPT, followed by booster at 4-7 year and another dose at 12-15 years of age [1]. However, the national immunization schedule in Universal Immunization Program (UIP) in India, recommends at least 7 doses of Tetanus vaccine are administered in various combinations (3 doses of DPT in infancy, 2 booster doses at 16-24 months and 5-6 years of age, 2 TTs at 10 and 16 years of age). The pregnant women get at least 2 additional doses in her life time for first pregnancy [2]. Adults get additional TT doses following injuries. This is suggestive that in India the TT vaccine is being overused for vaccination.

As a practitioner, I would like to know from the experts why booster of TT is given in India at 16-24 months, while it is not recommended by WHO? Why immunization schedule for Tetanus vaccine has 7 shots against WHO recommendation of 5 doses? Are these extra doses really necessary? For pregnant women and adults, who receive extra doses following injuries, does the current schedule poses any risk of hyper-immunization?


References

1. World Health Organization. Tetanus vaccine: WHO position paper. Weekly Epidemiol Rec. 2006;81:198-207.

2. Government of India. Immunization Handbook for Medical officers. Ministry of Health and Family Welfare, Nirman Bhawan, Government of India, New Delhi. 2009. p. 21.