Indication

TTvax vaccine is used for the prevention of tetanus in children 7 years of age or older and adults, especially those liable to be exposed to tetanus infection and persons engaged in outdoor activities e.g. gardeners, farm workers and athletes. TTvax vaccine is also used in the prevention of neonatal tetanus by immunizing women of childbearing age, and also in the prevention of tetanus following injury. The vaccine can be safely and effectively given simultaneously with BCG, Measles, Polio vaccines (IPV and OPV), Hepatitis B, Yellow fever vaccine, Haemophilus influenzae-B and Varicella vaccine.


Dosage & Administration

The full basic course of immunization against tetanus consists of two primary doses of 0.5 ml at least four weeks apart, followed by the third dose 6-12 months later. To maintain a high level of immunity further 0.5 ml. booster doses are recommended at every feasible interval (for adults usually 5 to 10 years).

 

Protection of the Newborn against Tetanus
For prevention of neonatal tetanus, TTvax is recommended for immunization of women of childbearing age, and especially pregnant women. TTvax may be safely administered during pregnancy and should be given to the mother at first contact or as early as possible in pregnancy. A five dose schedule is recommended for previously unimmunized women of childbearing age: after the basic course of immunization with three doses, two additional booster doses should be given, at least one year after the previous dose or during the subsequent pregnancy.

 

Vaccination of Injured Person
For those subjects who have proof of either completing their course of primary immunizations containing tetanus toxoid or receiving a booster shot within the previous 5 years no additional dose of tetanus toxoid is recommended. If more than 5 years have elapsed, and infection with tetanus because of injury or other cause is suspected, 0.5ml of the TTvax should be given immediately. Where the immunization history is inadequate 1500 IU (3000 old AU) tetanus antiserum and 0.5 ml TTvax should be injected, with separate syringes, to different body sites. (If available, 250 units of tetanus immune globulin (human origin) can be substituted for the tetanus antiserum). A second 0.5ml dose of TTvax is recommended after 2 weeks and a third dose after a further 1 month. (A note of caution: if horse-origin tetanus antiserum is used in prophylaxis, the patient should be tested for sensitivity to horse serum protein prior to its administration. It is desirable to have 1 ml of Adrenaline solution (1:1000) immediately available and the normal precautions followed when injecting antitoxins).

 

Method of Inoculation
TTvax should be injected intramuscularly into the deltoid muscle in women and older children. Only sterile needles and syringes should be used for each injection. The vaccine should be well shaken before use. Once opened, multi-dose vials should be kept between 2°C to 8°C.


Precautions

ADRENALINE INJECTION (1:1000) MUST BE MADE IMMEDIATELY AVAILABLE IF AN ACUTE ANAPHYLACTIC REACTION OCCURS DUE TO ANY COMPONENT OF THE VACCINE.
For treatment of severe anaphylaxis the initial dose of adrenaline is 0.1-0.5 mg (0.1-0.5 ml of 1:1000 injections) given s/c or i/m. Single dose should not exceed 1 mg (1ml). For infants and children, the recommended dose of adrenaline is 0.01mg/kg (0.01ml/kg of 1:1000 injection). Single paediatric dose should not exceed 0.5 mg (0.5ml). The mainstay in the treatment of severe anaphylaxis is the prompt use of adrenaline, which can be lifesaving. It should be used at the first suspicion of anaphylaxis. As with the use of all vaccines the vaccinees should remain under observation for not less than 30 minutes for possibility of occurrence of immediate or early allergic reactions. Hydrocortisone Sodium Succinate and antihistaminics should also be available in addition to supportive measures such as oxygen inhalation. There is an increased incidence of local and systemic reactions to booster doses of TT vax when given to previously immunized persons. Special care should be taken to ensure that the injection does not enter a blood vessel. It is extremely important when the parent, guardian, or adult patient returns for the next dose in the series, the parent, guardian, or adult patient should be questioned concerning occurrence of any symptoms and/or signs of an adverse reaction after the previous dose.


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