Tetanus immunisation following a wound or burn
What is tetanus?
Tetanus is a dangerous but preventable infection. It is caused by bacteria that live in soil and manure. The bacteria can enter the body through a wound or burn. Once in the body the bacteria release poisons that attack the body’s nervous system. This can cause severe muscular spasm, particularly in the jaw, hence its more common name “lockjaw”. It is important that everyone is immunised to prevent them getting tetanus following a wound or burn.
What does immunisation involve?
In adults (born after 1961) immunisation involves 3 vaccine injections over three months followed by further vaccine injections at five years and ten years to achieve lifelong cover. Vaccines make the body produce substances called antibodies which kill bacteria and stop the body getting the infection.
Who should be immunised against tetanus?
Everyone should be immunised against tetanus. Since 1961 all children were routinely offered a course of three doses of combined diphtheria, tetanus and pertussis vaccine injection. They were also offered one dose of polio vaccine which is given in an activated form by mouth. This vaccine has been associated with a small risk of causing polio as a side-effect, so now it is given in an inactive (non-living) form by injection.
Since 2004 all infants now receive a combined tetanus, diphtheria, pertussis, haemophilus influenza and polio vaccine injection. This is usually given at two, three and four months of age. Booster doses are given to make sure the body keeps producing antibodies. In adults, tetanus booster injections also contain a mixture of diphtheria and polio vaccines to boost the immunity of these other diseases at the same time. As these are combined in one vaccine, only one injection is given. A total of two booster doses of vaccine are needed to give lifelong immunity against tetanus.
What happens if I have a wound?
Depending on where and how you injured yourself you may be at risk of getting tetanus. Your doctor or nurse practitioner will ask you about any tetanus vaccines you have received before. This enables them to decide whether you will need to have the course of three vaccines, a booster dose or tetanus immunoglobulin.
If you need the course of three vaccines, you will receive the first in A&E. Your GP or nurse practitioner will be able to arrange for you to have the second and third vaccines. There should be a four week gap between injections. It is therefore important that you make an appointment to see your GP or nurse practitioner four weeks after coming to the A&E Department.
If you are at high risk of getting tetanus—for example, you have never been vaccinated or your wound is contaminated with soil or manure—you may also need to be given an immunoglobulin injection. Giving the immunoglobulin means that the body is protected immediately. If you need both immunoglobulin and a vaccine, these will be given at the same time but at different sites. Your doctor, GP or nurse practitioner will discuss with you what injections you need.
Why do I need to have a diphtheria as well as a tetanus booster?
Diphtheria is a potentially life threatening infection that affects breathing. Diphtheria immunisation was introduced in 1940 during the Second World War. As a result, uptake of the vaccine was poor, and the level of immunisation in those born before or during the war is low. In order to maintain a higher level of immunity it is advised that tetanus and low dose diphtheria boosters are always given together.
Is this immunisation safe?
Side-effects to the tetanus, diphtheria and polio combined vaccine are rare. Some people report pain, redness and swelling where the injection was given. These side-effects usually disappear within a few days.
Are there any reasons why I should not be immunised?
The only reasons not to be immunised are if you have experienced a severe reaction to this injection or any of its ingredients in the past. It is important that you inform your doctor, GP or nurse practitioner if you have had a previous reaction or develop a reaction after receiving this dose.
What about this vaccine in pregnancy?
It is important that pregnant women are immunised against tetanus in order to prevent risk to the unborn baby. You should consult your doctor or antenatal clinic for specific advice about this.
Benefits, risks and alternatives
Benefits of procedure
Immunisation prevents the development of tetanus infection following a wound or burn. In addition, the tetanus/diphtheria/polio combination vaccine helps to maintain the body’s defence against developing diphtheria and polio.
Risks of procedure
Immunisation may cause pain, redness and swelling where the injection is given. These side-effects usually disappear within a few days.
Alternative treatments
Immunisation is encouraged following a wound or burn. There are no alternatives to immunisation. If immunisation is not given there is a small but significant risk of developing tetanus following a wound or burn.