30.3.3   For immunisation of adults and children over ten years

Adults most likely to be susceptible to tetanus are the elderly, especially women and men who have not served in the Armed Forces.

a.    For primary immunisation the course consists of three doses of 0.5ml of adsorbed tetanus vaccine (T) by intramuscular or deep subcutaneous injection, with intervals of one month between each dose.  If there is no record of diphtheria immunisation either, then three doses of Td vaccine should be given.

b.   A reinforcing dose (T or Td) ten years after the primary course and again ten years later maintains satisfactory levels of protection which will probably be life-long.

c.    For immunised adults who have received five doses, either in childhood, or as above, booster doses are not recommended, other than at the time of tetanus prone injury, since they have been shown to be unnecessary and can cause considerable local reactions.  There are data that show that tetanus has occurred only exceptionally rarely in fully immunised individuals despite the passage of many years since the completing dose of a standard course of immunisation, and without subsequent routine boosting.  Cases that have occurred were not fatal.  There is therefore little justification for boosting with tetanus vaccine beyond the recommended 5 dose regimen.