Primary immunization for persons 7 years of age and older-

A series of three doses of 0.5 ml each, of adsorbed tetanus vaccine should be given intramuscularly

• First dose: At appropriate date
• Second dose: 4 to 8 weeks after the first dose
• Third dose: 6 to 12 months after the second dose

Children older than 7 years who did not complete primary immunization series (e.g., previously received only two doses of DTaP or DTP) need to receive only one dose of tetanus toxoid adsorbed vaccine to complete the primary series of tetanus. Interruption of the recommended schedule with a delay between doses does not interfere with the final immunity achieved with adsorbed tetanus vaccine. There is no need to start the series over again, regardless of the time elapsed between doses.

Routine booster injections: To maintain adequate protection, a booster dose of 0.5 ml of adsorbed tetanus vaccine every 10 years thereafter is recommended.

Vaccination of injured persons-

Clean and minor wound:

• If primary immunization confirmed and receiving booster dose within previous 5 years, no need of additional vaccine.
• If primary immunization confirmed and receiving booster dose more than previous 5 years, 1 dose of 0.5 ml required.

All other dirty wounds (contaminated with feces, soil, and saliva):

• If primary immunization confirmed and receiving booster dose within previous 5 years, 1 dose of 0.5 ml required.
• If primary immunization confirmed and receiving booster dose more than previous 5 years, 1 dose of 0.5 ml along with tetanus immunoglobulin required.

If a person has no previous vaccination or uncertain, the primary series of 3 doses of 0.5ml adsorbed tetanus vaccine should be given along with tetanus immunoglobulin with 1st dose.

Protection of neonatal tetanus-

For prevention of neonatal tetanus, adsorbed tetanus vaccine is recommended for immunization of women of childbearing age.

Women (15-49 Years): For pregnant woman who have not had previous immunization, 2 doses of tetanus toxoid at four weeks interval preferably during the last two trimester or at least 2 weeks before delivery should be given during pregnancy so that protective antibody would be transferred to the infant in order to prevent neonatal tetanus, e.g. 1 dose of 0.5 ml at 6th month of pregnancy and 1 dose of 0.5 ml at 7th month of pregnancy. Pregnant woman who have completed the course of tetanus, next 10 years no need of additional dose during pregnancy. Thereafter a single booster dose would be sufficient to extend immunity.