Pharmacology · Bacterial and antimalarial vaccines

Tetanus vaccine (tetanus toxoid) !

Inactivated tetanus toxin that induces protective antibodies. It prevents tetanus, including neonatal tetanus, and is usually combined with diphtheria vaccine.

Updated 2026-11-01

Class: Bacterial and antimalarial vaccines
Target: Immune response against tetanospasmin (tetanus toxin)
ATC code: J07AM01
WHO Model List of Essential Medicines

Also called: Tetanus toxoid, TT, Td (combined with diphtheria toxoid)

Immune response against tetanospasmin (tetanus toxin)Tetanus vaccine (tetanus toxoid)

The figure shows Clostridium tetani tetanus neurotoxin bound to the ganglioside GD1a, its receptor on neurons. The vaccine contains this toxin in inactivated form (toxoid).

Target in 3D: Immune response against tetanospasmin (tetanus toxin). PDB structure 5N0B (RCSB PDB, public domain). View the structure at RCSB PDB

Mechanism of action

The toxoid is inactivated tetanospasmin: it no longer blocks release of inhibitory neurotransmitters but keeps its epitopes. It induces IgG that neutralises the toxin if Clostridium tetani spores germinate in a wound. The disease itself leaves no immunity, because the amount of toxin that causes it is too small to trigger a response.

Toxoid (inactivated toxin) is injected into muscle
B and T cells recognise its epitopes and form memory
Circulating IgG neutralises toxin before it reaches the neuron
Boosters keep antibody levels up throughout life

Pharmacokinetics

Distribution: Vaccine-induced maternal IgG crosses the placenta and protects the newborn
Onset and duration: Protection builds with the primary series and is maintained with boosters

Indications

Prevention of tetanus in the childhood series, combined with diphtheria and pertussis
Vaccination of women of reproductive age and pregnant women to prevent neonatal tetanus
Wound management when vaccination history is incomplete or unknown, together with tetanus immunoglobulin if the wound is not clean and minor

Adverse effects

Common

Pain, redness and swelling at the injection site
Low-grade fever and malaise

Contraindications

Previous anaphylaxis to a dose or to a vaccine component
Precaution: history of an Arthus-type reaction to a toxoid; the next booster is deferred

Key interactions

Tetanus immunoglobulin: Used together for tetanus-prone wounds: the immunoglobulin protects at once and the toxoid starts or completes the body's own immunity

What is monitored

Vaccination history (number of previous doses) before managing a wound
Local reaction over the following hours

Administration and safety

Intramuscular route
With tetanus immunoglobulin, at a different anatomical site and with a different syringe
Check whether the product is toxoid alone or combined (Td, DTP) before giving it

Nursing care

Ask about and record previous tetanus toxoid doses
Classify the wound (clean and minor or tetanus-prone) to decide whether immunoglobulin is added
Observe the patient for a few minutes after vaccination for allergic reaction
Explain that local pain and low fever are expected and short-lived

Pregnancy and breastfeeding

Recommended in pregnancy when the woman is not protected: it is the basis of neonatal tetanus prevention.

Test yourself

Think of the answer, then tap the question to see it.

Why should a person who survived tetanus be vaccinated?

The toxin is so potent that the amount causing disease is not enough to induce antibodies; without vaccination the person remains unprotected.

How does the vaccine prevent neonatal tetanus?

By vaccinating women of reproductive age or during pregnancy: antitoxin IgG crosses the placenta and protects the newborn, alongside clean delivery and cord care.

According to WHO, how many doses of tetanus-toxoid-containing vaccine give lifelong protection?

Six: three primary doses plus three boosters.

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Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: Tetanus (World Health Organization, 2026); Chapter 21: Tetanus | Pink Book | CDC (Centers for Disease Control and Prevention, 2021); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026); eEML - Electronic Essential Medicines List (World Health Organization, 2025).

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Representative model, for educational purposes only.