International travel and health



Tetanus vaccine is available as monovalent tetanus toxoid (TT), in bivalent combination with diphtheria toxoid (DT) or low-dose diphtheria toxoid (Td), or as trivalent vaccine that also includes whole-cell (wP) or acellular (aP) pertussis vaccine.

In some countries, combination vaccines with hepatitis B, Haemophilus influenzae type b and/or IPV exist. Vaccines containing DT are used for children under 7 years of age and Td-containing vaccines for those aged 7 years and over. Vaccine combinations containing diphtheria toxoid (D or d) and tetanus toxoid, rather than tetanus toxoid alone, should be used when immunization against tetanus is indicated.

A childhood immunization schedule of five doses is recommended. The primary series of three doses of DTP (DTwP or DTaP) should be given in infancy, with a booster dose of a tetanus toxoidcontaining vaccine ideally at age 4–7 years and another booster in adolescence, e.g. at age 12–15 years. Those who have received the primary series plus two booster doses, the last of which given in early adulthood, are unlikely to require further doses.

All travellers should be up to date with the vaccine before departure. The type of tetanus prophylaxis that is required following injury depends on the nature of the lesion and the history of previous immunizations. However, no booster is needed if the last dose of the primary series, or of subsequent booster injections, was given less than 5 years ago for dirty wounds or less than 10 years ago for clean wounds.