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When should I take the tetanus injection during pregnancy?

Answered by: Dr B Shakuntala Baliga MD (AIIMS), FICOG

Professor and Senior Consultant Gynecologist & Colposcopist Mazumdar-Shaw Center for Cancer Research & Narayana Hrudayalaya Multispecialty Hospital, Bangalore

Q. My 27 years old wife has taken the first tetanus injection at the 3.5 months of pregnancy. Is it fine if she takes her second tetanus injection after 5.5 months?

A.  The second injection is administered 4 weeks after the first injection.

If your wife has not received the full primary series of tetanus vaccine immunization [i.e. of 3 doses in infancy, 4th at 4-7 years and 5th around 7-12 years of age), or is uncertain, then she needs to receive 3 doses- starting at first visit (anytime in pregnancy)], 2nd injection is given 4 weeks after 1st and 3rd injection 6 months after 2nd injection. The 4th and 5th injections are administered at 1 yearly interval, thereafter (after pregnancy), to complete the course. However, if she has received the full primary vaccination, but has not received the booster within last 10 years, she needs to take 2 injections (at first visit, and second 4 weeks later). If she has received the booster within last 10 years, then she needs to take only one injection.

These days, instead of plain tetanus toxoid, WHO is recommending Td (i.e. tetanus toxoid with low-dose diphtheria vaccine) during pregnancy. WHO also recommends, that if the woman has received the booster injection within previous 2 years, she can take TdaP (tetanus toxoid, low-dose diptheria vaccine and vaccine against acellular pertussis) soon after delivery, rather than Td before delivery.

However, Government of India recommends tetanus toxoid (TT) during pregnancy, and I follow the GOI recommendations.

A.  The second injection is administered 4 weeks after the first injection.

If your wife has not received the full primary series of tetanus vaccine immunization [i.e. of 3 doses in infancy, 4th at 4-7 years and 5th around 7-12 years of age), or is uncertain, then she needs to receive 3 doses- starting at first visit (anytime in pregnancy)], 2nd injection is given 4 weeks after 1st and 3rd injection 6 months after 2nd injection. The 4th and 5th injections are administered at 1 yearly interval, thereafter (after pregnancy), to complete the course. However, if she has received the full primary vaccination, but has not received the booster within last 10 years, she needs to take 2 injections (at first visit, and second 4 weeks later). If she has received the booster within last 10 years, then she needs to take only one injection.

These days, instead of plain tetanus toxoid, WHO is recommending Td (i.e. tetanus toxoid with low-dose diphtheria vaccine) during pregnancy. WHO also recommends, that if the woman has received the booster injection within previous 2 years, she can take TdaP (tetanus toxoid, low-dose diptheria vaccine and vaccine against acellular pertussis) soon after delivery, rather than Td before delivery.

However, Government of India recommends tetanus toxoid (TT) during pregnancy, and I follow the GOI recommendations.

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