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Does Your Child Need a Tetanus Shot or Not?

I’ve had parents often come into the emergency room after their child has taken a tumble asking for a Tetanus vaccine, which is why I felt the need to write a post explaining what Tetanus is and why we need to vaccinate our kids.

WHAT IS TETANUS?

Tetanus is a disease commonly known as lockjaw. It is caused by the bacteria, Clostridium tetani and can be fatal. The toxin from the bacteria affects the nervous system and causes severe painful muscle spasms, which can interfere with the ability to breathe. Currently there is no cure for Tetanus and treatment is mainly symptomatic until the effects of the toxin wear off. Complete recovery can take up to several months.

WHERE IS THE BACTERIA FOUND?

Clostridial spores can be found everywhere. They are found in soil, dust and animal faeces (including humans). Once the spores enter a wound they grow into mature bacteria, which produce the powerful toxin. Clostridium tetani is found worldwide.

WHAT ARE THE SIGNS AND SYMPTOMS OF TETANUS?

Signs and symptoms of tetanus can appear anytime from a few days to a few weeks from infection:

  • Spasms and stiffness of jaw muscles (hence the name lockjaw);
  • Spasms and stiffness of the neck muscles;
  • Difficulty swallowing;
  • Spasms and stiffness of other body muscles, commonly the abdominal muscles;
  • Other constitutional symptoms such as fever, sweating and palpitations.

TETANUS VACCINATION

I won’t go into too much detail regarding the various combination vaccines as there are many and every country has its own recommendations. A copy of the latest South African immunisation schedule can be downloaded from my resources page. The WHO recommends an initial 6-dose schedule to achieve tetanus immunity.

1. Primary vaccination

Three primary doses of the vaccine are recommended in childhood starting from 6 weeks.

2. Booster vaccination

Three booster doses are recommended prior to adolescence. Booster vaccines are then recommended every 10 years thereafter.

TETANUS-PRONE WOUND

  • This is any wound that has been contaminated with material that could contain tetanus spores;
  • This is any wound that is deep;
  • This is any wound that is dirty;
  • This is any wound that contains a foreign body.

Note: any wound can be tetanus-prone – cuts, scrapes, burns, animal (including human) and insect bites.

WHEN TO SEE A DOCTOR

It is recommended you see a doctor if:

  • Your child has a tetanus-prone wound and has not had a booster vaccine in the last 5 years;
  • Your child has a minor, clean wound and has not had a booster vaccine in the last 10 years;
  • Your child has a wound and you cannot remember when their last booster vaccine was.

RESOURCES

CDC (2018) Tetanus. [online]. Available from: https://www.cdc.gov/vaccines/pubs/pinkbook/tetanus.html#contraindications [Accessed 30 August 2018].

WHO (2018) Tetanus vaccines: WHO position paper, February 2017 – Recommendations. Vaccine. [online] 36 (25). Available from: http://dx.doi.org/10.1016/j.vaccine.2017.02.034 [Accessed 30 August 2018].

WHO (2018) Tetanus. [online]. http://www.who.int/ith/vaccines/tetanus/en/ [Accessed 30 August 2018].

Child Immunisation Schedule SA

South Africa offers an extensive child immunisation program. All these vaccines are available at public clinics for free. Private clinics also offer an immunisation program, however, some fee may be involved, as not all medical aids pay for the vaccines. The private schedule offers more vaccines than state clinics and there may also be differences in schedules between private and public.

The following two tables below outline the different immunisation schedules.

Department Of Health Extended Program Of Immunisation (EPI) Schedule:

AGE OF CHILD VACCINATION PROTECTS AGAINST
Birth BCG Bacillus Calmette Guerin Tuberculosis
OPV (0) Oral polio vaccine: OPV-Merieux/Polioral Polio
6 weeks OPV (1) Polio
RV (1) Rotavirus vaccine: Rotarix Rotavirus
DTaP-IPV-Hib-HBV (1) Hexavalent: Hexaxim Diphtheria, tetanus, acellular pertussis (whooping cough), polio, haemophilus influenzae type B, Hepatitis B
PCV 13 (1) Pneumococcal conjugate vaccine: Prevenar-13 Pneumococcal diseases
10 weeks DTaP-IPV-Hib-HBV (2) Diphtheria, tetanus, whooping cough, polio, haemophilus influenzae type B, Hepatitis B
14 weeks RV (2) Rotavirus
DTaP-IPV-Hib-HBV (3) Diphtheria, tetanus, whooping cough, polio, haemophilus influenzae type B, Hepatitis B
PCV 13 (2) Pneumococcal diseases
6 months Measles (1) MeasBio Measles
9 months PCV 13 (3) Pneumococcal diseases
12 months Measles (2) Measles
18 months DTaP-IPV-Hib-HBV (4) Diphtheria, tetanus, whooping cough, polio, haemophilus influenzae type B, Hepatitis B
6 years Td (1) Diftavax Tetanus, Diptheria
9 years (girls only) HPV (1) (repeat 6 months later) Human papilloma Virus
HPV (2) Human papilloma Virus
12 years Td (2) Diftavax Tetanus, Diptheria

 

Private Practice Child Immunisation Schedule:

AGE OF CHILD VACCINATION PROTECTS AGAINST
Birth BCG Bacillus Calmette Guerin Tuberculosis
OPV (0) Oral polio vaccine: OPV-Merieux/Polioral Polio
6 weeks OPV (1) Polio
RV (1) Rotavirus vaccine: Rotarix/RotaTeq Rotavirus
DTaP-IPV-Hib-HBV (1) Hexavalent: Hexaxim/Infanrix-Hexa Diphtheria, tetanus, acellular pertussis (whooping cough), polio, haemophilus influenzae type B, Hepatitis B virus
PCV 13 (1) Pneumococcal conjugate vaccine: Prevenar-13/Synflorix Pneumococcal diseases
10 weeks RV (2) Rotavirus
DTaP-IPV-Hib-HBV (2) Diphtheria, tetanus, whooping cough, polio, haemophilus influenzae type B, HBV
PCV 13 (2) Pneumococcal diseases
14 weeks RV (2) or (3) Rotavirus
DTaP-IPV-Hib-HBV (3) Diphtheria, tetanus, whooping cough, polio, haemophilus influenzae type B, HBV
PCV (3) Pneumococcal diseases
6 months + Flu Influenza vaccine Influenza
9 months Measles (1) Rouvax

Or

MMR (1) Trimovax/Priorix

Measles

 

Measles, mumps, rubella

MCV (1) Meningococcal vaccine: Menactra Meningococcal diseases
12 -15 months MMR (1) or (2)

Or

MMRV (1) Priorix Tetra

Measles, mumps, rubella

 

Measles, mumps, rubella, chickenpox

Varicella (1) Varilrix Chicken pox
PCV (4) Pneumococcal disease
MCV (2) Meningococcal disease
HAV (1) Hepatitis A vaccine: Avaxim 80/Havrix Junior (repeat 6 months later) Hepatitis A virus
18 months DTaP-IPV-Hib-HBV (4) Diphtheria, tetanus, whooping cough, polio, haemophilus influenzae type B, HBV
18-21 months HAV (2) Avaxim 80/Havrix Junior Hepatitis A virus
5-6 years

 

MMR (2) or (3)

Or

MMRV (2)

Measles, mumps, rubella

 

Measles, mumps, rubella, chickenpox

Varicella (2) Chicken pox
DTaP Infanrix

Or

DTaP-IPV Quadrivalent: Adacel Quadra/Boostrix Tetra

Diptheria, tetanus, whooping cough

 

DTaP plus polio

9 years + (girls & boys; 13 years) HPV (1) Gardasil/Cervarix (girls only) (repeat 6 months later) Human papilloma Virus
HPV (2) Human papilloma Virus
12 years

 

TdaP-IPV Diphtheria, tetanus, whooping cough, polio

 

RESOURCES

National Institute for Communicable Disease (2016) Vaccine Information for Parents and Caregivers. [Online] Available from: http://www.nicd.ac.za/assets/files/NICD_Vaccine_Booklet_D132_FINAL.pdf [Accessed 29 June 2018].

Netcare, (2016). Vaccine Schedules for South Africa for 2016. [Online] Available from: http://www.netcarehospitals.co.za/Portals/3/Images/Content-Images/PDF/latest-vaccine-schedule.pdf [Accessed 30 June 2018].

The National Department of Health, (2015). Vaccinator’s Manual “Immunisation That Works” Expanded Programme on Immunisation in South Africa (EPI-SA). [Online] Available from: https://www.westerncape.gov.za/assets/departments/health/vaccinators_manual_2016.pdf [Accessed 29 June 2018].

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