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    Diphtheria and Tetanus Toxoid Vaccine Immunization Schedule

    Diphtheria and Tetanus Toxoid Vaccine Immunization Schedule

    At present, Advisory Committee on Immunization Practice (ACIP) recommends Td vaccine instead of tetanus toxoid vaccination to protect against diphtheria, since diphtheria spread again especially in adults.

    Vaccination against tetanus for who has injury that may be contaminated with tetanus bacteria.  At present, there is always recommended Td (or DT or DTP, if children less than 7 years of age) instead of single tetanus vaccine (tetanus toxoid: T) (as shown on table).

    Table 1 Recommended at minimum ages and intervals between dosesUntitled2Reference: Book of Vaccine and EPI 2013 (ตำราวัคซีนและการเสริมภูมิคุ้มกันโรคปี 2556)  (2013). Table 2.1, page 33

    Table 2 Age interval of target group in the Expanded Programm on Immunization (EPI), Ministry of Public HealthUntitled1.2 Reference: Book of Vaccine and EPI 2013 (ตำราวัคซีนและการเสริมภูมิคุ้มกันโรคปี 2556)  (2013). Table 6.1, page 72

    Td vaccine for adult is recommended as below.

    – Adult who have not been previously vaccinated, have to be vaccinated 1st dose when have a chance such as immunization campaign or injury. Then, appoint to be vaccinated until complete 3-dose schedule by 0, 1, 6 months of interval and booster every 10 years.

    – Adult who have been previously vaccinated no matter how long but not complete 3 doses of schedule, have to be vaccinated until it is completed. The interval between 1st and 2nd doses is 1 month and the interval between 2nd and 3rd doses is 6 months

    – Adult who have been finished vaccination in childhood, (DTP 5 times and Td when 11-16 years of age or in grade 6), should be boosted with Td every 10 years.

    – If those who have never received Tdap, should be vaccinated Tdap instead of Td 1 shot, especially when there is any infant in family. Tdap should hastily be given to all adults in the family to prevent pertussis spread to infant. In this case, should give Tdap vaccination regardless of the interval after Td or T vaccination at the previous vaccination.

    Table 3 Schedule of tetanus and diphtheria combined (Td) vaccine vaccination for pregnancyUntitledRemark: In case of receiving tetanus containing vaccine, if after giving Td vaccine then there are symptoms of severe pain and swelling more than usual such as whole arm swelling, unable to lift their arms (Arthus reaction). This indicate that there is still have immunity to tetanus in high levels. They should delay next Td vaccination for 10 years.

    Table 4 Tetanus Toxoid Vaccine Immunization Schedule for Wound Management*Untitled4

    *   Such as wounds that lacerated or contaminated with soil, sand or dirt, specially puncture wound.

    ** Consider use 1 dose of Tdap instead of Td to whom have not previously received Tdap.

    *** Tetanus immune globulin (TIG) 250 unit or equine antitoxin 1,500 unit. Equine antitoxin always requires skin testing before using.

    Vaccination against tetanus for who has injury that may be contaminated with tetanus bacteria.  At present, there is always recommended Td (or DT or DTP, if children less than 7 years of age) instead of single tetanus vaccine (tetanus toxoid: T) (as shown on table).

    1. For those who have received vaccination of T or Td or DTP or DT, completed with 3-dose schedule within 5 years, no need to be boosted every 10 years.
    2. If those who have received vaccination of T or Td or DTP or DT, completed with 3-dose schedule more than 5 years’, they should be boosted with Td (DT or DTP in children less than 7 years of age) single vaccination.
    3. If those who have received vaccination of T or Td or DTP or D T with incomplete of schedule or have not received or not sure about history of vaccination, they should receive Td (or DT or DTP, in children less than 7 years of age) with completed 3-dose schedule. If there are mortal wound, dirty or the doctor suspect tetanus infection, tetanus antitoxin should be shot with intramuscular administration in the other site of vaccination (table 4).
    4. For HIV/AIDS patient or immunocompromised host with tetanus-prone wounds must be shot tetanus antitoxin with intramuscular administration regardless of prior vaccination history.

     

    Reference: Book of Vaccine and EPI 2013 (ตำราวัคซีนและการเสริมภูมิคุ้มกันโรคปี 2556)  (2013).  Department of disease control, Ministry of Public Health.  from http://e-lib.ddc.moph.go.th/pdf/material-25/material-25.pdf