Tetanus/Diphtheria Information for Ob-gyns
NEW! CDC has created a Tdap for Pregnant Women information for provider’s 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.
*Special Notes Regarding Td/Tdap Vaccination During Pregnancy:
If a Td booster vaccination is indicated during pregnancy (ie, more than 10 years since the previous Td vaccination) then health care providers should administer Tdap during pregnancy, preferably between 27 weeks and 36 weeks of gestation (6). Because of the nonurgent nature of this indication, waiting until 27–36 weeks of gestation appears to be the appropriate management plan to obtain maternal immunity and maximize antibody transfer to the newborn.
As part of standard wound management care to prevent tetanus, a tetanus toxoid-containing vaccine is recommended in a pregnant woman if 5 years or more have elapsed since her previous tetanus and diphtheria (Td) vaccination. If a Td booster vaccination is indicated in a pregnant woman for acute wound management, health care providers should administer Tdap irrespective of gestational age. A pregnant woman should not be re-vaccinated with Tdap in the same pregnancy if she received the vaccine in the first or second trimester.
The California Department of Public Health (CDPH), Immunization Branch is pleased to announce that the webinar Increasing Tdap Immunization Rates and Running an Efficient Immunization Practice: Tips from OBs, is now available for on-demand viewing. The free 1-hour program provides 1 unit of CME (physicians) or 1 unit of CEU (nurses) for California practitioners.
Three OB physician panelists describe their experiences integrating Tdap immunization into their busy California- based OB-GYN practices. Experts from the CDPH Immunization Branch discuss:
· The latest data and resources providers can utilize in their efforts to ensure adherence to Tdap vaccine recommendations during pregnancy.
· How to access free online training and job aids to support vaccine administration, vaccine storage and handling, and other nuts and bolts of maximizing the efficiency of your immunization practice.
Last Updated: 9/24/2014
Tetanus/Diphtheria Information for Patients
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” 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.
Diphtheria is 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 Patients for more information about Tdap. All pregnant women should receive a Tdap vaccination in every pregnancy, preferably during the third trimester, although the vaccine is safe at any time during pregnancy.
Pregnant women who have not received a Td vaccine within the last 10 years should receive a booster dose, and should preferably receive Tdap instead of Td.
To ensure protection against maternal and neonatal tetanus, pregnant women who have never been vaccinated against tetanus should begin the three-vaccination series, containing tetanus and reduced diphtheria toxoids, during pregnancy. The recommended schedule for this vaccine series is 0, 4 weeks, and 6–12 months; Tdap should replace one dose of Td, preferably given between 27 weeks and 36 weeks of gestation.
The Immunization Action Coalition has written Standing Orders for Administering Tetanus-Diphtheria Toxoids & Pertussis Vaccine (Td/Tdap) to Adults.
Last Updated: 7/18/2014