Tetanus/Diphtheria Information for Ob-gyns
New! CDC has created a Tdap for Pregnant Women information for providers page.
Tetanus is the only vaccine preventable disease that is not transmitted between persons; it enters the body through a break in the skin. Tetanus causes painful muscle spasms and can cause lockjaw, preventing an infected individual from swallowing.
Respiratory diphtheria presents as a sore throat with low-grade fever and an adherent membrane of the tonsils, pharynx, or nose. Neck swelling is usually present in severe disease. The lining on the throat can lead to breathing difficulties.
The vaccine for Tetanus and Diphtheria is given as a combination vaccine, Td, or combined with the pertussis vaccine, Tdap.
If your patient has not received a Tdap vaccine, it should be given to patients regardless of interval since the last tetanus- or diphtheria-toxoid containing vaccine. There are two vaccines to prevent pertussis approved for use in the United States. Boostrix (GlaxoSmithKline) is approved for people aged 10 through 64 years. Adacel (sanofi) is approved for use in persons aged 11 through 64 years. Both Tdap products are licensed for use at an interval of at least 5 years between the tetanus and diphtheria toxoids (Td) and Tdap dose.
Pregnant women should receive Td vaccine if indicated. Previously vaccinated pregnant women who have not received a Td vaccination within the last 10 years should receive a booster dose.
Pregnant women who have not received three doses of a vaccine containing tetanus and diphtheria toxoids should complete a series of 3 vaccinations. Two doses of Td should be administered during pregnancy to ensure protection against maternal and neonatal tetanus. The preferred schedule in pregnant women is two doses of Td separated by 4 weeks, and a dose of Tdap 6 months after the second dose (post-partum). Healthcare providers can choose to substitute a single dose of Tdap for a dose of Td during pregnancy if the patient is in a situation for increased risk of transmitting pertussis. Healthcare providers can choose to administer Tdap instead of Td to protect against pertussis in pregnant adolescents for routine or "catch-up" vaccination because the incidence of pertussis is high among adolescents, in pregnant healthcare personnel and child care providers to prevent transmission to infants younger than 12 months of age and to other vulnerable persons, and in pregnant women employed in an institution or living in a community with increased pertussis activity.
Although no evidence exists that tetanus and diphtheria toxoids are teratogenic, waiting until the second trimester of pregnancy to administer Td is a reasonable precaution for minimizing any concern about the theoretical possibility of such reactions.
Tetanus/Diphtheria Information for Patients
Read the College's Committee Opinion on Tdap and remember to get vaccinated!
Tetanus is a very serious disease caused by bacteria. It is not spread from person to person, but enters the body through a break in the skin. Tetanus causes painful muscle spasms, cramping, and stiffness. Sometimes the muscle cramps are strong enough to cause “lockjaw” pr paralysis. With lockjaw, the person cannot swallow. With paralysis, the person cannot move and has breathing problems. About 20% of people with tetanus die from the disease. Other symptoms of tetanus include high fever and seizures.
Diphtheriais another serious disease caused by bacteria. It spreads from person to person by coughing or sneezing. The infection starts out like the common cold, causing sore throat with low-grade fever and chills. Next, the bacteria coat the back of the nose or throat, making it hard to breathe. This lining can be bluish, gray, or green and can cause neck swelling when the disease is severe. About 10% of people with diphtheria die from the disease. In children younger than age 5 years, 20% may die.
The best way to prevent tetanus and diphtheria is to get the vaccine. The vaccine for these diseases is given as a combination vaccine, called Td. All people age 19 years and older should get a booster dose of Td every 10 years.
The vaccine can also be combined with the pertussis (whooping cough) vaccine and is called Tdap.
All adults who have not received a Tdap vaccine should get it even if they have already had a vaccine for tetanus or diphtheria. This vaccine is given only once. See the College’s Pertussis Information Page for Patientsfor more information about Tdap.
Td is safe for pregnant women in their second and third trimesters.Pregnant women who have not received a Td vaccine within the last 10 years should receive a booster dose. If they have not received three doses of any vaccine for tetanus and diphtheria, they should complete a series of three vaccinations. Two doses of Td should be given during pregnancy to protect both the mother and the newborn from tetanus. The second dose should be given 4 weeks after the first. A dose of Tdap should be given 6 months after the second Td dose and after delivery. Tdap can be given during the pregnancy if the woman is at high risk for getting or spreading pertussis. These pregnant women include adolescents, health care and child care providers, and pregnant women who work or live in a community with high rates of pertussis.
The Immunization Action Coalition has writtenStanding Orders for Administering Tetanus-Diphtheria Toxoids & Pertussis Vaccine (Td/Tdap) to Adults.