- Tetanus (Lockjaw)
- What Is a Tetanus Shot (DTaP)?
- DTaP Vaccine for Children
- Tetanus Booster Shots
- Tetanus Shot in Pregnant Women
- Side Effects of the DTaP Vaccine
- A Look at Each Vaccine: Diphtheria, Tetanus and Pertussis Vaccines
Tetanus is an uncommon but very dangerous disease — of every 10 people who get it, as many as 2 will die. Thanks in part to tetanus vaccines, deaths from tetanus in the United States have dropped by 99% since 1947.
There are 4 vaccines that include protection against tetanus:
- The DTaP vaccine protects young children from diphtheria, tetanus, and whooping cough
- The DT vaccine protects young children from diphtheria and tetanus
- The Tdap vaccine protects preteens, teens, and adults from tetanus, diphtheria, and whooping cough
- The Td vaccine protects preteens, teens, and adults from tetanus and diphtheria
Why are tetanus vaccines important?
Because of the vaccines, tetanus is rare — but people still get the disease. When they do, the complications can be serious and even deadly. People who get it can have trouble breathing and painful muscle spasms that are strong enough to break bones. Tetanus can also cause paralysis (not being able to move).
There’s no cure for tetanus. Getting vaccinated is the best way to prevent tetanus.
What is tetanus?
Tetanus is caused by a type of bacteria. You may have heard tetanus called “lockjaw” — that’s because one of the most common signs is painful tightening in the jaw muscles that can make it hard to open the mouth, breathe, or swallow.
Other symptoms of tetanus can include:
- Fever and sweating
- Stiff muscles
- Seizures (sudden, unusual movements or behavior)
- High blood pressure and fast heart rate
Tetanus isn’t contagious — it doesn’t pass from person to person, like through touching or kissing. The bacteria that cause tetanus can be in dirt, dust, and poop. Usually, the bacteria enter the body through broken skin, like:
- A deep cut or wound, like from stepping on a nail
- Burns or dead skin
Learn more about tetanus.
Who needs to get tetanus vaccines?
Everyone needs tetanus vaccines throughout their lives. That means everyone needs to get vaccinated as babies, children, and adults.
Infants and children birth through age 6
Young children need the DTaP vaccine as part of their routine vaccine schedule. Young children need a dose of the vaccine at:
- 2 months
- 4 months
- 6 months
- 15 through 18 months
- 4 through 6 years
If your child has had a serious reaction to the whooping cough part of the DTaP vaccine, they may be able to get the DT vaccine instead. Your child’s doctor can recommend the vaccine that’s right for your child.
See the routine vaccination schedule for:
- Infants and children
- Preteens and teens
Preteens and teens ages 7 through 18
Older children need 1 booster shot of the Tdap vaccine at age 11 or 12 as part of their routine vaccine schedule.
If your child misses the booster shot, talk with your child’s doctor about catching up.
Adults age 19 and older
Adults need 1 booster shot of the Td vaccine every 10 years as part of their routine vaccine schedule. If you get a deep cut or a burn, you may need the booster earlier — especially if the cut or burn is dirty.
If you missed the Tdap booster as a teen, you’ll need to get a Tdap booster instead to make sure you have protection from whooping cough.
Pregnant women need 1 booster shot of the Tdap vaccine during the third trimester of each pregnancy.
Talk with your doctor about how to protect your family from tetanus.
Who should not get tetanus vaccines?
You should not get a tetanus vaccine if you:
- Have a serious allergy to any ingredient in the vaccine
- Have had a serious reaction to the diphtheria, tetanus, or whooping cough vaccines in the past
Be sure to tell your doctor before getting vaccinated if you:
- Have seizures or other nervous system problems
- Had serious pain or swelling after any diphtheria, tetanus, or whooping cough vaccine
- Have had Guillain-Barré Syndrome (an immune system disorder)
If you’re sick, you may need to wait until you’re feeling better to get a tetanus vaccine.
What are the side effects of tetanus vaccines?
Side effects are usually mild and go away in a few days. They may include:
- Pain, swelling, or redness where the shot was given
- Low fever and chills
- Headache and body aches
- Feeling tired
- Upset stomach, throwing up, and diarrhea (watery poop)
- Not feeling hungry
- Fussing (in children)
It’s very rare, but the DTaP vaccine can cause the following symptoms in children:
Like any medicine, there’s a very small chance that tetanus vaccines could cause a serious reaction. Keep in mind that getting a tetanus vaccine is much safer than getting tetanus. Learn more about vaccine side effects.
Where can I get more information about tetanus vaccines?
Vaccine Information Statements (VISs) have detailed information about recommended vaccines. Read the VISs for vaccines that protect against tetanus:
- DTaP vaccine — protects against diphtheria, tetanus, and whooping cough (for infants and children)
- Tdap vaccine — protects against diphtheria, tetanus, and whooping cough (for preteens, teens, and adults)
- Td vaccine — protects against diphtheria and tetanus (for preteens, teens, and adults)
Find the VISs for these vaccines in other languages.
What Is a Tetanus Shot (DTaP)?
The tetanus vaccine has been proven safe and effective.
Due to the tetanus vaccine, tetanus is rare in the United States and other developed countries, with around one million cases reported across the world each year.
Most cases in the United States occur in people who haven’t received the tetanus vaccination or who haven’t stayed up-to-date on their 10-year booster shots.
Before the vaccine, there were more than 500 cases of tetanus reported annually in the United States.
DTaP Vaccine for Children
DTaP vaccination is a shot that combines the vaccines for tetanus, diphtheria, and pertussis (whooping cough).
The DTaP vaccine creates antibiodies against the tetanus toxin for at least 10 years.
The vaccine shot is administered to children in the following way:
- One dose each at 2 months, 4 months, and 6 months of age
- A fourth dose at 15 through 18 months of age
- A fifth dose at 4 through 6 years of age
Tetanus Booster Shots
To maintain protection from tetanus throughout life, people need to receive booster vaccines.
When children are 11 or 12 years old, they should get a booster vaccine called Tdap (which protects against tetanus, diphtheria, and pertussis).
Starting at 19 years old, adults need a booster called the Td vaccine (for tetanus and diphtheria) every 10 years.
For people who never received Tdap, the vaccine should be given once, before age 65, as a substitute for Td.
It’s important to stay up-to-date with your booster shots, especially if you plan to travel to developing countries because tetanus may be more common where you’re visiting.
Before traveling, check with your doctor about when you received your last booster shot.
Tetanus Shot in Pregnant Women
Newborn babies whose mothers weren’t immunized can catch a form of neonatal tetanus that usually occurs through infection of the unhealed umbilical stump, particularly when the stump is cut with an unsterile instrument.
This form of tetanus causes the death of around 200,000 newborns annually.
However, if a mother has been immunized no more than 10 years before becoming pregnant or if she receives the vaccination during her pregnancy, she can protect her baby from tetanus because she passes antibodies to the baby across the placenta.
The Centers for Disease Control and Prevention (CDC) recommends that pregnant women who received the last dose of a tetanus vaccine more than 10 years prior to becoming pregnant should be immunized with Td during the second and third trimester instead of Tdap.
If their last tetanus toxoid-containing vaccine was less than 10 years ago, the CDC says she should wait until after delivery to receive Tdap.
Side Effects of the DTaP Vaccine
A serious reaction to the DTaP vaccine occurs in fewer than 1 in a million children. The most common side effects usually occur in about 1 out of 4 children. These include:
- Redness, swelling, and pain where the shot was given
Other side effects include the following:
- A fever over 105 degrees in 1 out of 16,000 children
- Nonstop crying for 3 hours or more occurs in about 1 out of 1,000 children
- Seizures occur in about 1 out of 14,000 children, but do not cause long-term harm
A Look at Each Vaccine: Diphtheria, Tetanus and Pertussis Vaccines
- Plotkin SA, Orenstein W, Offit PA and Edwards KM. Diphtheria Toxoid in Vaccines, 7th Edition. 2018, 261-275.
- Plotkin SA, Orenstein W, Offit PA and Edwards KM. Tetanus Toxoid in Vaccines, 7th Edition. 2018, 1052-1079.
- Plotkin SA, Orenstein W, Offit PA and Edwards KM. Pertussis Vaccines in Vaccines, 7th Edition. 2018, 711-761.
Specific topic references
Pertussis vaccine and neurologic complications
Top KA, Brna P, Ye L, Smith B. Risk of seizures after immunization in children with epilepsy: a risk interval analysis. BMC Pediatr 2018;18:134.
The authors analyzed the risk of seizures after immunization in children with epilepsy less than 7 years of age. Nearly half of the immunization visits that occurred after epilepsy diagnosis were characterized by receipt of DTaP. The risk of seizures was not increased 0-14 days after any vaccine. The authors concluded that children with epilepsy do not appear to be at increased risk of seizures following immunization. These findings suggest that immunization is safe in children with epilepsy.
Lateef TM, Johann-Liang R, Kaulas H, Hasan R, Williams K, et al. Seizures, encephalopathy, and vaccines: experience in the National Vaccine Injury Compensation Program. J Pediatr 2015;166:576-581
The authors described the demographic and clinical characteristics of children younger than 2 years of age for whom claims were filed with the National Vaccine Injury Compensation Program (VICP) alleging seizure disorder or encephalopathy or both during a one-year period. In 80 percent of these claims, a pertussis-containing vaccine was implicated, and four times more often related to the whole-cell pertussis vaccine. Seizure disorder was the primary condition for which compensation was sought and less than half of the claimants were known to have been febrile at the time of presentation. A significant number of children with alleged vaccine injury had pre-existing neurologic or neurodevelopmental abnormalities. Among those developing chronic epilepsy, many had clinical features suggesting that the epilepsy had a genetic basis.
Daley MF, Yih WK, Glanz JM, Hambidge SJ, Narwaney KJ, et al. Safety of diphtheria, tetanus, acellular pertussis and inactivated poliovirus (DTaP-IPV) vaccine. Vaccine 2014;32:3019-3024.
The authors examined the risk of serious, but uncommon, adverse events after receipt of DTaP-IPV in more than 200,000 children 4-6 years of age during a four-year period via the Vaccine Safety Datalink project. Receipt of DTaP-IPV did not significantly increase the risk of meningitis/encephalitis, seizures, stroke, Guillain-Barré syndrome, Stevens-Johnson syndrome, anaphylaxis, serious allergic reactions, or serious local reactions.
Sun Y, Christensen J, Hviid A, Li J, Vedsted P, et al. Risk of febrile seizures and epilepsy after vaccination with diphtheria, tetanus, acellular pertussis, inactivated poliovirus, and Haemophilus influenzae type b. JAMA 2012;307(8):823-831.
The authors evaluated the risk of febrile seizures and epilepsy in more than 300,000 children who received DTaP-IPV-Hib at ages 3, 5, and 12 months in Denmark during a six-year period. DTaP-IPV-Hib vaccination was not associated with an increased risk of febrile seizures in children within seven days following receipt of vaccine compared with those children beyond seven days of vaccination. Sub-analyses indicated an increased risk of febrile seizures on the day of the first two vaccinations, although absolute risk was small. DTaP-IPV-Hib vaccination was not associated with an increased risk of epilepsy.
Huang WT, Gargiullo PM, Broder KR, Weintraub ES, Iskander JK, et al. Lack of association between acellular pertussis vaccine and seizures in early childhood. Pediatrics 2010;126(2):e263-e269.
The authors investigated the incidence of seizures following receipt of DTaP during a 10-year period in more than 430,000 children aged 6 weeks to 23 months. They found no significant increase in the risk of seizures following receipt of DTaP.
Yih WK, Nordin JD, Kulldorff M, Lewis E, Lieu TA, et al. An assessment of the safety of adolescent and adult tetanus-diphtheria-acellular pertussis (Tdap) vaccine, using active surveillance for adverse events in the Vaccine Safety Datalink. Vaccine 2009;27:4257-4262.
The safety of Tdap was monitored weekly among subjects aged 10-64 years during 2005-2008 with specific attention to encephalopathy-encephalitis-meningitis, paralytic syndromes, seizures, cranial nerve disorders, and Guillain-Barré syndrome (GBS). No evidence of an association between Tdap and any of these adverse events was found during a three-year-surveillance period that included more than 660,000 Tdap doses. GBS and cranial nerve sub-analyses found no statistically significant temporal clustering within 42 days after vaccination.
Ray P, Hayward J, Michelson D, Lewis E, Schwalbe J, et al. Encephalopathy after whole-cell pertussis or measles vaccination: lack of evidence for a causal association in a retrospective case-control study. Pediatr Infect Dis J 2006;25:768-773.
The authors investigated the possible relationship between whole-cell pertussis (DTP) or measles (MMR) vaccination and encephalopathy, encephalitis, and Reye syndrome by evaluating 15 years of health records from four health maintenance organizations in the United States, which encompassed nearly 2.2 million children. DTP and MMR vaccines were not associated with an increased risk of encephalopathy, encephalitis, or Reye syndrome after vaccination. Additionally, a clinically distinctive pertussis vaccine-induced encephalopathy was not detected, which was consistent with other studies.
Le Saux N, Barrowman NJ, Moore DL, Whiting S, Scheifele D, et al. Decrease in hospital admissions for febrile seizures and reports of hypotonic-hyporesponsive episodes presenting to hospital emergency departments since switching to acellular pertussis vaccine in Canada: a report from IMPACT. Pediatrics 2003;112:e348-e353.
The authors compared the incidence of hospital admissions for febrile seizures and hypotonic-hyposresponsive episodes (HHEs) presenting to hospital emergency departments before and after transition from DTP to DTaP in Canada. Hospital admissions secondary to pertussis vaccine-related febrile seizures and HHEs associated with pertussis vaccine decreased by 79 percent and 60-67 percent %, respectively.
Barlow WE, Davis RL, Glasser JW, Rhodes PH, Thompson RS, et al. The risk of seizures after receipt of whole-cell pertussis or measles, mumps and rubella vaccines. N Engl J Med 2001;345:656-661.
The authors investigated the relationship between DTP and MMR and the risk of a first seizure, subsequent seizures and neurodevelopmental disability in children. During the three-year period, more than 340,000 DTP vaccines and more than 130,000 MMR vaccines were administered. Receipt of DTP vaccine was associated with an increased risk of febrile seizures only on the day of vaccination (six to nine febrile seizures per 100,000 children vaccinated). Receipt of MMR vaccine was associated with an increased risk of febrile seizures eight to 14 days after vaccination (25-34 febrile seizures per 100,000 children vaccinated). DTP and MMR were not associated with an increased risk of non-febrile seizures. Children with febrile seizures after vaccination were not found to be at a higher risk for subsequent seizures or neurodevelopmental disabilities as compared with their unvaccinated counterparts. The authors concluded that the increased risk of febrile seizures secondary to DTP and MMR do not appear to be associated with any long-term, adverse consequences.
Goodwin J, Nash M, Gold M, Heath TC, Burgess MA. Vaccination of children following a previous hypotonic-hyporesponsive episode. J Paediatr Child Health 1999;35:549-552.
Hypotonic-hyporesponsive episodes (HHE) were once considered a contraindication to pertussis vaccination in Australia. In this study, the authors evaluated the safety of further vaccination in children who had experienced an HHE (95 percent experienced with whole-cell pertussis and 80 percent after the first dose). Researchers found no HHE or serious reactions after subsequent DTaP, DTP, or DT. The authors concluded that previously healthy children who experience HHE reactions can safely continue standard vaccination schedules.
Vermeer-de Bondi PE, Labadie J, Rumke HC. Rate of recurrent collapse after vaccination with whole cell pertussis vaccine: follow up study. BMJ 1998;316:902-903.
The authors conducted a follow-up study of 84 children in the Netherlands with reported collapse after their first whole cell pertussis vaccination (DTP) to determine the rate of recurrence in those who received subsequent doses of DTP. None of the children had recurrent collapse, and other adverse events were only minor.
Greco D, Salmaso S, Mastrantonio P, Giuliano M, Tozzi A, et al. A controlled trial of two acellular vaccines and one whole cell vaccine against pertussis. N Engl J Med 1996;334:341-348.
The authors compared the efficacy and safety of two acellular pertussis vaccines with whole-cell pertussis and DT alone in more than 14,000 children within six to 28 weeks of life. DTwP was found to have a significantly higher rate of local and systemic reactions, including local swelling and tenderness, irritability, fever, persistent crying for ≥ 3 hours, and hypotonic/hyporesponsive episodes with those receiving DTaP. Events following receipt of DTaP were similar to the control group that received DT alone. Seizures were either infrequent or did not occur in the vaccine groups.
Gustafsson L, Hallander HO, Olin P, Reizenstein E, Storsaeter J. A controlled trial of a two-component acellular, a five-component acellular, and a whole-cell pertussis vaccine. N Engl J Med 1996;334:349-356.
The authors compared the efficacy and safety of a two-component acellular pertussis vaccine, a five-component acellular pertussis vaccine, a whole-cell pertussis and DT alone in more than 9,000 children within the first six months of life. DTP was found to have a significantly higher rate of local and systemic reactions, including protracted crying, cyanosis, fever, and local reactions compared with both DTaP vaccines and DT. DTaP rates of these events were similar to the control group who received DT alone. Seizures occurred infrequently in the 48 hours after any vaccine receipt, and rates were similar among all groups.
Rosenthal S, Chen R, Hadler S. The safety of acellular pertussis vaccine vs whole-cell pertussis vaccine. Arch Pediatr Adolesc Med 1996;150:457-460.
In December 1991, the FDA licensed the first diphtheria, tetanus toxoid, and acellular pertussis vaccine (DTaP) for use in children aged 15 months to 7 years. In this study, the authors analyzed post-marketing surveillance data submitted to the Vaccine Adverse Event Reporting System (VAERS) between late 1990 and late 1993 to determine whether serious but uncommon adverse events are less frequent after DTaP as compared with whole-cell pertussis (DTP) vaccine receipt. An estimated 27 million DTP doses (with or without Haemophilus influenzae type b vaccine) and 5 million DTaP doses were administered during this period. DTaP was associated with significantly fewer total adverse event reports, as well as significantly fewer reports of subcategory adverse events (fever, seizures or hospitalization), compared with DTP.
Gale JL, Thapa PB, Wassilak SGF, Bobo JK, Mendelman PM, et al. Risk of serious acute neurological illness after immunization with diphtheria-tetanus-pertussis vaccine. JAMA 1994;271:37-41.
The authors prospectively identified children between mid-1987 and mid-1988 in Washington and Oregon states to evaluate the association between receipt of whole-cell pertussis vaccine and serious acute neurological illness within seven days of vaccination. Among an estimated 368,000 DTP vaccines administered, no increased risk of serious acute neurological illness including complex febrile seizures, afebrile seizures, infantile spasms, or acute encephalitis/encephalopathy was detected.
Blumberg DA, Lewis K, Mink CM, Christenson PD, Chatfield P, et al. Severe reactions associated with diphtheria-tetanus-pertussis vaccine: detailed study of children with seizures, hypotonic-hyporesponsive episodes, high fevers and persistent crying. Pediatrics 1993;91:1158-1165.
The authors prospectively evaluated children in Los Angeles, California, between 1986 and 1990 to determine causes and risk factors for severe DTP reactions within 48 hours of vaccine receipt. Children with seizures had a high rate of personal and family histories of seizures, and 90 percent had documented fevers. Persistent crying was associated with painful local reactions. Neither lymphocytosis nor hypoglycemia occurred. No biologically active pertussis toxin was found in the acute sera of children experiencing possible severe DTP reactions. As acellular pertussis vaccines have less endotoxin, which is thought to lead to febrile seizures, the authors concluded that use of acellular vaccines should lead to a reduction in DTP-related seizures due to a decrease in febrile events. Acellular pertussis vaccines also have lower local and systemic reaction rates compared with the whole cell vaccine utilized in this study; therefore, persistent crying may also be reduced.
Griffin MR, Ray WA, Mortimer EA, Fenchel GM, Schaffner W. Risk of seizures and encephalopathy after immunization with the diphtheria-tetanus-pertussis vaccine. JAMA 1990;263:1641-1645.
The authors evaluated the risk of seizures and other neurological events, including encephalopathy, following DTP immunization in Denmark in more than 38,000 children who received about 107,000 DTP immunizations in the first three years of life. The authors found no increased risk of febrile or afebrile seizures in the 0- to three-day window following immunization when compared with 30 or more days after vaccine receipt. Two cases of encephalitis were reported, but onset occurred more than two weeks after vaccine receipt.
Griffith AH. Permanent brain damage and pertussis vaccination: is the end of the saga in sight? Vaccine 1989;7:199-210.
The author provides an overview of the pertussis vaccine and controversies surrounding its possible link to permanent brain damage. Reports of permanent brain damage thought secondary to receipt of the pertussis vaccine were published in the 1950s through 1970s. Most notably, a case series suggesting permanent brain damage secondary to pertussis vaccination out of the National Hospital for Sick Children by Kulenkampff and colleagues was the subject of a United Kingdom television documentary in 1974 that resulted in a significant decline in vaccination rates and a consequent resurgence of pertussis in England. Repercussions from this documentary in the UK included the establishment of expert panels and sponsored research teams by the Department of Health and Social Security to examine existing clinical data and to carry out prospective studies including the North West Thames study (see Pollock, et al, Lancet 1983 data reported below) and the National Childhood Encephalopathy Study (NCES).
The NCES evaluated reported cases of defined serious neurological disorders arising in children between 2 and 36 months of age admitted to the hospital between mid-1976 and mid-1979 in the UK. These researchers estimated the attributable risk of neurological damage after pertussis immunization to be 1 in 310,000-330,000 injections, but the report was limited by certain structural biases and incomplete information; furthermore, these results could not be reproduced in subsequent studies.
The Kulenkampff and NCES data were reexamined in the High Court of Justice, London, in the wake of neurologic damage claims brought to the court. Regarding the Kulenkampff data, more than half of the cases either could not be linked to pertussis vaccination (e.g., DT given instead of DTP), had normal outcomes, or were found to have alternative causes. Reexamination of the NCES data showed
- No previously normal child suffered permanent brain damage with an onset within 48 hours of vaccination
- No evidence supported the notion that previously neurologically abnormal children had a greater risk than normal children of suffering an event within a short period following vaccination
- Of the 12 previously normal cases of “serious neurological disorder” with onset within the first 48 hours, 10 were cases of febrile convulsions and those with prolonged convulsions were normal at follow-up
- If the cases of Reye’s syndrome and of viral origin were excluded— given that they are not caused by DTP — no cases of permanent brain damage or death were linked to the vaccine
- The figure of 1 in 310,000 or 330,000 given as the attributable risk of permanent brain damage following DTP vaccine could not be supported
- Evidence supports that on rare occasions, DTP causes febrile convulsions
Livengood JR, Mullen JR, White JW, Brink EW, Orenstein WA. Family history of convulsions and use of pertussis vaccine. J Pediatr 1989;115:527-531.
The authors evaluated data from the CDC Monitoring System for Adverse Events Following Immunization during the period of 1979 to 1986 to determine the risk of neurologic events after vaccination with DTP in patients with a family history of convulsions compared with those without a family history. Children with a family history of seizures had an increased risk of neurologic events, primarily febrile convulsions, after DTP receipt, but this increase in risk may reflect a nonspecific familial tendency for convulsions rather than a specific vaccine effect as well as selection bias. Given the rare occurrence of neurologic events after DTP vaccination, the generally benign outcome of febrile convulsions that accounted for more than 75 percent of the events, and the risk pertussis caused by not vaccinating people with a family history of convulsions, the authors concluded that a history of convulsions in a close relative should not be a contraindication to the pertussis vaccination. Rather, prevention of post-vaccination fever may be warranted in these children.
Baraff LJ, Shields WD, Beckwith L, Strome G, Marcy SM, et al. Infants and children with convulsions and hypotonic-hyporesponsive episodes following diphtheria-tetanus-pertussis immunization: follow up evaluation. Pediatrics 1988;81(6):789-794.
In a previous prospective study (Cody, et al Pediatrics 1981), the authors found that minor reactions (e.g., local redness, swelling, fever, etc.) were more common following DTP immunization than DT. Among more than 15,000 DTP injections, nine children developed seizures and nine developed hypotonic-hyporesponsive episodes though no sequelae were detected following these possible temporal reactions. The authors completed a follow-up evaluation six to seven years later in 16 of these children to determine if any had evidence of neurologic impairment too subtle to have been detected at the time of their initial evaluation. All 16 children were considered to be normal by their parents and — as determined by their school performance — had no evidence of serious neurologic damage.
Shields WD, Nielsen C, Buch D Jacobsen V, Christenson P, et al. Relationship of pertussis immunization to the onset of neurologic disorders: a retrospective epidemiologic study. J Pediatr 1988;113:801-805.
The authors examined the temporal relationship between onset of neurologic disorders and the time of pertussis vaccine in children immunized with either DTP or monovalent pertussis at different ages. They found no relationship between the age of onset of epilepsy and scheduled age of administration of pertussis vaccine; however, a relationship existed between scheduled age of administration and first febrile seizure, which occurred more commonly with the third dose in the series between 10-15 months of age. No relationship between pertussis immunization and the occurrence of central nervous system infections was noted.
Walker AM, Jick H, Perera DR, Knauss TA, Thompson RS. Neurologic events following diphtheria-tetanus-pertussis immunization. Pediatrics 1988;81(3):345-349.
The authors assessed the frequency of serious neurologic events following administration of 106,000 DTP immunizations in children between 1977 and 1983. They found no cases of acute unexplained encephalopathy temporally associated with vaccination. The onset of one serious seizure disorder occurred within three days of immunization, with 1.13 cases expected on the basis of chance alone. The incidence of recorded febrile seizures in the immediate post-immunization period was 3.7 times that in the period 30 days or more after immunization.
Bellman MH, Ross EM, Miller DL. Infantile spasms and pertussis immunisation. Lancet 1983;321(8332):1031-1034.
The authors investigated the possible role of pertussis immunization and other factors in the etiology of infantile spasms reported to the National Childhood Encephalopathy Study between 1976 and 1979 in England, Scotland and Wales. No significant association was found between infantile spasms and pertussis immunization in the 28 days following vaccination.
Corsellis JA, Janota I, Marshall AK. Immunization against whooping cough: a neuropathological review. Neuropathol Appl Neurobiol 1983;9(4):261-270.
The authors examined published data on childhood deaths which were thought to be due to receipt of the pertussis vaccine and identified an additional 29 children in England and Wales whose deaths between 1960 and 1980 had been reported as occurring in relation to DTP and had post-mortem examinations. Deaths occurred within three weeks or up to 12 years after DTP receipt. Upon autopsy, various cerebral abnormalities were found; however, none of the cases in this study or in previous published reports had demonstrated a recurring pattern of inflammatory or other damage that could be accepted as a specific reaction to pertussis immunization. Reactive changes that were occasionally found appear to be indistinguishable from those seen in other infantile encephalopathies.
Pollock TM and J Morris. A 7-year survey of disorders attributed to vaccination in North West Thames Region. Lancet 1983;1(8327):753-757.
The authors examined the relationship between pertussis and other vaccines and neurological problems over a seven-year period. All children reported to have serious or unusual vaccine reactions, regardless of severity, had records investigated and were physically examined by an area health authority medical officer four weeks after the original report; and all children, except for those with mild symptoms, had a developmental examination six months after the report. In a group of hundreds of thousands of children and more than 400,000 DTP immunizations, 20 reports of convulsions within three weeks of DTP were reported and three-quarters of the reports were febrile seizures within 48 hours of immunization; all children were developmentally normal on follow-up. Twelve neurological disorders were reported to have occurred within eight weeks of DTP receipt; 11 of which had either infantile spasms, infectious etiology, or epilepsy, none of which were linked to DTP. The authors concluded that their study does not support the claim that DTP produces a syndrome characterized by a previously healthy child who presents with continuous screaming, collapse, convulsion and arrested mental development.
Melchior JC. Infantile spasms and early immunization against whooping cough: Danish survey from 1970 to 1975. Arch Dis Child 1977;52:134-137.
The authors examined the relationship between immunization and the onset of infantile spasms over a six-year period in Denmark after a change in its immunization program. Previously, DTP vaccine had been administered at 5, 6, and 15 months of age, but was changed in 1970 to monovalent pertussis vaccine at 5 weeks, 9 weeks, and 10 months of age. The authors found no differences in the age at onset of infantile spasms between immunized and non-immunized children; half of all cases in each group began before 5 months of age despite children immunized before 1970 not receiving the first dose until 5 months of age.
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What Is Tetanus?
Tetanus, also known as lockjaw, is a serious but preventable disease that affects the body’s muscles and nerves.
Starting at 2 months of age, all babies in the United States are vaccinated against tetanus. The disease is much more common in developing countries than it is in the United States.
What Causes Tetanus?
Tetanus is caused by a type of
called Clostridium tetani that usually live in soil. The bacteria make a toxin (a chemical or poison that harms the body). This toxin attaches to nerves around a wound area and travels inside the nerves to the brain or spinal cord. There it interferes with the normal activity of nerves, especially the motor nerves that send direct messages to muscles.
In the United States, most cases of tetanus follow a contaminated cut or deep puncture injury, such as a wound caused by stepping on a nail. Sometimes the injury is so small the person never even sees a doctor.
Tetanus is most common in:
- injuries that involve dead skin, such as burns, frostbite, gangrene, or crush injuries
- wounds contaminated with soil, saliva (spit), or feces, especially if not cleaned well
- skin punctures from nonsterile needles, such as with drug use or self-performed tattooing or body piercing
What Is Neonatal Tetanus?
Another form of tetanus, neonatal tetanus, happens in newborns born in unsanitary conditions, especially if the umbilical cord stump becomes contaminated. Routine immunizations and sanitary cord care have made newborn tetanus very rare in developed countries.
What Are the Signs & Symptoms of Tetanus?
Tetanus often begins with muscle spasms in the jaw (called trismus). Someone also can have trouble swallowing and stiffness or pain in the muscles of the neck, shoulders, or back. The spasms can spread to the muscles of the belly, upper arms, and thighs. The symptoms can happen days to months after exposure to the bacteria.
How Is Tetanus Treated?
Someone who has tetanus will be treated in a hospital, usually in the intensive care unit (ICU). There, they usually get antibiotics to kill bacteria and tetanus immune globulin (TIG) to neutralize the toxin already released. They’ll also get medicines to control muscle spasms and may need treatment to support vital body functions.
Can Tetanus Be Prevented?
Yes. The two most important ways to prevent tetanus are:
- getting vaccinated against tetanus
- getting a shot (post-exposure tetanus prophylaxis) after an injury that could cause tetanus
Tetanus immunization is part of the DTaP (diphtheria, tetanus, and acellular pertussis) vaccinations. Kids usually get:
- a series of four doses of DTaP vaccine before 2 years of age
- another dose at 4–6 years of age
- a booster (Tdap) at 11–12 years of age, or later if it was missed
Then, they should get a tetanus and diphtheria (Td) booster every 10 years through adulthood.
The Tdap vaccine is also recommended for all pregnant women during the second half of each pregnancy, regardless of whether they had the vaccine before, or when it was last given.
Neonatal tetanus can be prevented by making sure that all pregnant women have had their tetanus immunizations, by delivering babies in sanitary conditions, and by proper umbilical cord care.
Post-exposure tetanus prophylaxis involves getting tetanus shots after an injury. Shots given will depend on:
- when the patient last had a booster
- the total number of tetanus vaccinations the patient has had
- the nature of the wound
Any skin wound — especially a deep puncture or a wound that may be contaminated with feces, soil, or saliva — should be cleaned and dressed right away.
When Should I Call the Doctor?
If you’re not sure whether your kids have gotten their tetanus vaccinations, or if you know they’re not fully immunized, call your doctor. If it’s been more than 10 years since someone in your family got a tetanus booster, see your doctor to bring immunizations up to date.
If a puncture or other deep wound happens, clean the wound and call the doctor to ask about post-exposure tetanus prophylaxis. If your child develops lockjaw or muscle spasms — particularly after a wound — get medical care right away.
Reviewed by: Ryan J. Brogan, DO Date reviewed: July 2018