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Immunization Dialogue Indian Pediatrics 2000;37: 795-796 |
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Should Tetanus Toxoid be Administered Every 5 Years |
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Because of the presence of the cow and horse dung on our roads, our people are more prone to sustain tetanus prone injuries as compared to people in advanced countries where the roads are less likely to be con-taminated by the animal excreta. Occasionally an apparently minor injury may introduce Clostridium tetani infection. If TT is administered every 5 years, then the high antibody levels can take care of the small amounts of the toxins introduced in such instances. If TT vaccine is given every 5 years instead of 10 years as recommended presently, need for the expensive tetanus immune globulin can be eliminated. TT given every 5 years would cost additional 4-5 rupees per person per year.
1. Paul Y, John TJ. Immunization against tetanus. Indian Pediatr 1998; 35: 477-478. 2. Paul Y, John TJ. Role of DPT or TT vaccines after injury or as prophylaxis. Indian Pediatr 1999; 36: 198-199. Yash Paul,
As Dr. Yash Pal points out, tetanus prophylaxis was discussed in two sessions of Immunization Dialogue in Indian Pediatrics. In case of ‘tetanus-prone’ injury, both passive and active immunization are recommended only in persons who have been only partially immunized with one or two doses in the past. This recommendation applies irrespective of the gap between the last dose and the present injury; the 5-year cut-off does not apply here. In those who had been fully immunized (with at least 3 doses in the past), only an immediate booster dose of tetanus toxoid (TT) is sufficient if more than 5 years have elapsed. The cut-off of 5 years is the guideline to give one booster dose of TT for tetanus-prone injury in fully immunized persons. If the injury is within 5 years of the last dose of TT, provided that it was the third dose or a dose of a higher order, then there is not even the need for a booster. If the third or subsequent dose had been more than 10 years ago, then a booster is recommended for any type of injury, irrespective of the level of risk. If the wound was not tetanus-prone, then no booster is needed for up to 10 years. In summary, what we must ensure is the full course of immunization in every person, with a minimum of 3 doses of TT, followed by routine boosters every 10 years. For young children, 3 doses for primary immunization and 2 booster doses (as DPT for 4 doses and DT for 5th dose) are recommended under the Universal Immunization Programme. IAP recommends 5 doses of DPT itself. Following either course, routine boosters of TT are needed only once in 10 years. There is no need for boosters every 5 years. T. Jacob John, |
