Tetanus inoculation

Tetanus infection occurs when wounds become contaminated, which is facilitated by the presence of necrotic tissue; newborns become infected through the umbilical wound; the clinical picture reflects the action of the neurotoxin. The tetanus vaccine creates individual immunity and immunological memory, so that in the event of injury a booster dose of the vaccine is used instead of equine antitetanus serum.

The goal of the WHO Regional Office for Europe is to eliminate neonatal tetanus by 2005 or earlier. Tetanus incidence in Russia has been reduced to isolated cases; there are no neonatal tetanus cases. In developing countries, pregnant women are vaccinated twice to prevent neonatal tetanus, i.e., one tetanus vaccination and a second booster shot.

Drugs for emergency tetanus prophylaxis

For emergency prevention, both monovalent anatoxin and immunoglobulins are used.

Tetanus toxoid purified adsorbed (Microgen, Russia) is a tetanus toxoid that contains 20 EU per 1 ml, available in 1 ml ampoules (2 doses).

Human anti-tetanus immunoglobulin PSCHI - ampoules of 250 and 500 ME. (Microgen, Russia and Sichuan Yuanda Shuyan, China - TD Allergen).

Equine anti-tetanus serum purified concentrated (Russia) - PSS - in ampoules of 3000 IU (1 dose).

Shelf life: tetanus toxoid and antitetanus serum - 3 years, PSCHI - 2 years, stored at a temperature of 2-8°

Emergency post-exposure prophylaxis

It is performed in cases of injuries with damage to the integrity of the skin and mucous membranes, frostbite and 2nd-4th degree burns, extra-hospital abortions and childbirth, gangrene and tissue necrosis, penetrating wounds of the gastrointestinal tract, animal bites.

Emergency specific prophylaxis of tetanus

Previous vaccinations	Age	Period after vaccination	Anti-tetanus drugs used last AC1 (ml) PSCHI2 or PSS (ME)
Vaccination documents are available
Full course of vaccinations according to age 3	Children and teenagers	Any term	Do not enter 4	They do not enter
Course of routine vaccinations without the last age-related revaccination	Children and teenagers	Any term	0.5 ml	They do not enter
Full course of immunization 5	Adults	< 5 years > 5 years	They do not enter 0.5 ml	They do not enter They do not enter
Two vaccinations 6	All ages	< 5 years > 5 years	0.5 ml 1.0 ml	Do not enter 7 250 or 3000 8
One vaccination	All ages	< 5 years > 5 years	0.5 ml 1.0 ml	Do not enter 7 250 or 3000 8
Not vaccinated	< 5 months. > 5 months		They do not enter 1.0 ml	250 or 3000 8 250 or 3000 8
There is no documentary evidence of previous vaccinations.
Vaccination history is unknown, there were no contraindications to vaccinations	< 5 months. > 5 months, teenagers, military personnel, including former ones		They do not enter 0.5 ml	250 or 3000 Do not enter 7
Other contingents	All ages		1.0 ml	250 or 3000 8

Notes:

1. For emergency prevention of tetanus, it is possible to use ADS-M.
2. It is preferable to administer PSCHI; if this drug is not available, then antitetanus serum should be administered.
3. 3 This also applies to children and adolescents who were vaccinated outside the schedule but received revaccination: regular scheduled or emergency revaccinations due to injuries should be done no more than once every 5 years.
4. For infected wounds, if more than 5 years have passed since the previous revaccination, 0.5 ml of tetanus toxoid is administered.
5. The full course of immunization with AC for adults consists of two vaccinations of 0.5 ml each with an interval of 30-40 days and revaccination after 6-12 months with the same dose. With a shortened schedule, the full course of immunization includes a single vaccination against tetanus with tetanus toxoid in a double dose (1 ml) and revaccination after 6-12 months with a dose of 0.5 ml.
6. Two vaccinations according to the standard immunization schedule (for adults and children) and one vaccination according to the shortened immunization schedule for adults.
7. For infected wounds, PSCHI or PSS is administered.
8. All persons who have received active-passive prophylaxis, in order to complete the immunization course and to eliminate the need for repeated administration of PSS after 6-12 months, must be revaccinated with 0.5 ml of tetanus toxoid.

Before administering anti-tetanus serum, an intradermal test with 1:100 diluted serum - 0.1 ml (located in the box with the drug - marked in red) is mandatory. Persons with a positive skin test (swelling and hyperemia diameter of 1 cm or more) are contraindicated from receiving anti-tetanus serum. Persons with a negative test are administered 0.1 ml of undiluted serum subcutaneously and, if there is no reaction after 30 minutes, the remaining dose. A syringe with adrenaline should be ready.

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Vaccination reactions and complications after tetanus vaccination

The introduction of tetanus toxoid can cause the same reaction as ADS (ADS-M). PSCHI is slightly reactogenic. Immediate allergic reactions (including anaphylactic shock) are possible to the introduction of anti-tetanus serum - immediately after the introduction or after several hours: early - on the 2nd-6th day and late - on the 2nd week and later (serum sickness syndrome). Considering the possibility of shock in people with a negative skin test, each vaccinated person is provided with observation for 1 hour. Annual tetanus vaccinations, previously carried out for scouts in the USA before leaving for camps, led to the development of brachial neuritis (the only consequence of "hyperimmunization")