Yes

Toxoid

Active immunity against diphtheria and tetanus when pertussis vaccine is contraindicated; tetanus prophylaxis in wound management

Td: Children and adults greater than or equal to 7 years of age

C

Clinical effects on the fetus: Td and T vaccines are not known to cause special problems for pregnant women or their unborn babies. While physicians do not usually recommend giving any drugs or vaccines to pregnant women, a pregnant women who needs Td vaccine should get it; wait until 2nd trimester if possible.

Patients receiving immunosuppressive agents, prior anaphylactic, allergic, or systemic reactions; hypersensitivity to diphtheria and tetanus toxoid or any component; acute respiratory infection or other active infection

History of a neurologic reaction or immediate hypersensitivity reaction following a previous dose. History of severe local reaction (Arthus-type) following previous dose (such individuals should not be given further routine or emergency doses of tetanus and diphtheria toxoids for 10 years). Do not confuse pediatric DT with adult diphtheria and tetanus toxoid (Td), absorbed (Td) is used in patients >7 years of age; primary immunization should be postponed until the second year of life due to possibility of CNS damage or convulsion; have epinephrine 1:1000 available.

Severe adverse reactions must be reported to the FDA

1% to 10%:

Central nervous system: Persistent crying

Gastrointestinal: Anorexia, vomiting

<1%: Tachycardia, hypotension, edema, convulsions (rarely), pain, redness, urticaria, pruritus, tenderness, Arthus-type hypersensitivity reactions, transient fever

Decreased effect with immunosuppressive agents, immunoglobulins if given within 1 month (eg, concomitant administration with tetanus immune globulin decreased the immune response to Td)

Refrigerate

I.M.:

6 weeks to 1 year: Three 0.5 mL doses at least 4 weeks apart; administer a reinforcing dose 6-12 months after the third injection

1-6 years: Two 0.5 mL doses at least 4 weeks apart; reinforcing dose 6-12 months after second injection; if final dose is given after seventh birthday, use adult preparation

4-6 years (booster immunization): 0.5 mL; not necessary if all 4 doses were given after fourth birthday - routinely administer booster doses at 10-year intervals with the adult preparation

Children >7 years and Adults: Should receive Td; 2 primary doses of 0.5 mL each, given at an interval of 4-6 weeks; third (reinforcing) dose of 0.5 mL 6-12 months later; boosters every 10 years.

Tetanus prophylaxis in wound management (Use of tetanus toxoid (Td*) and/or tetanus immune globulin (TIG) depends upon the number of prior tetanus toxoid doses and type of wound):

• For clean, minor wounds:

If prior number of tetanus toxoid doses is unknown or <3: Td*

If prior number of tetanus toxoid doses is greater than or equal to 3: Td* only if >10 years since last dose

If only three doses of fluid tetanus toxoid have been received, a fourth dose of toxoid, preferably an adsorbed toxoid, should be given

• For all other wounds:

If prior number of tetanus toxoid doses is unknown or <3: Td* and TIG

If prior number of tetanus toxoid doses is greater than or equal to 3: Td* only if >5 years since last dose

*Adult tetanus and diphtheria toxoids; use pediatric preparations (DT or DTP) if the patient is <7 years old.

Adapted from Report of the Committee on Infectious Diseases, American Academy of Pediatrics, Elk Grove Village, IL: American Academy of Pediatrics, 1986.

Give only I.M.

DT, Td and T vaccines cause few problems (mild fever or soreness, swelling, and redness/knot at the injection site); these problems usually last 1-2 days, but this does not happen nearly as often as with DTP vaccine

Shake well before giving

Injection:

Diphtheria 6.6 Lf units and tetanus 5 Lf units per 0.5 mL (5 mL)

Diphtheria 10 Lf units and tetanus 5 Lf units per 0.5 mL (0.5 mL, 5 mL)

Diphtheria 12.5 Lf units and tetanus 5 Lf units per 0.5 mL (5 mL)

Diphtheria 15 Lf units and tetanus 10 Lf units per 0.5 mL (5 mL)

Adult use:

Diphtheria 1.5 Lf units and tetanus 5 Lf units per 0.5 mL (0.5 mL, 5 mL)

Diphtheria 2 Lf units and tetanus 5 Lf units per 0.5 mL (5 mL)

Diphtheria 2 Lf units and tetanus 10 Lf units per 0.5 mL (5 mL)

Bentley DW, "Vaccinations," Clin Geriatr Med, 1992, 8(4):745-60.

Gardner P and Schaffner W, "Immunization of Adults," N Engl J Med, 1993, 328(17):1242-8.