Tetanus toxoid vaccine is available as single toxoid (TT), combined with diphtheria toxoid (DT) or low-dose diphtheria toxoid (Td), and combined with diphtheria and pertussis vaccines (whole pertussis wP or acellular pertussis aP) (DTwP, DTaP, or TdaP). 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 5 doses is recommended. The primary series of 3 doses of DTP (DTwP or DTaP) should be given in infancy, with a booster dose of a tetanus toxoid-containing 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 was 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 tetanus vaccine was given less than 5 (for dirty wounds) to 10 years (for clean wounds) previously.