Tetanus Information & Questionnaire
for Employees, Fellows, & Non-compensated Appointees
Information
About Tetanus
Tetanus, a bacterial disease that affects the nervous system, is caused by the common bacterium Clostridium tetani that is
widespread throughout our environment and commonly found in dust, soil, insects and animals. This bacterium can enter
the body through wounds as small as a pinprick or scratch. Unlike other vaccine preventable disease, tetanus is not
transmitted from person to person.
A tetanus infection can be difficult to diagnose and complicated to treat, taking weeks or months for recovery.
Approximately 11% of reported cases of tetanus are fatal. Older adults have an increased risk of tetanus and diphtheria
compared to children and young adults; this is likely because older adults may not have received the initial series of
injections to establish protection, or because many adults may have simply forgotten to stay up-to-date with a booster
every 10 years.
The most common form of tetanus causes paralysis, usually starting at the top of the body and working its way down.
Common first signs of tetanus are a headache and muscular stiffness in the jaw (lockjaw) followed by stiffness if the neck,
difficulty in swallowing, rigidity of abdominal muscles, spasms, sweating, fever, elevated blood pressure, and rapid
heartbeat. Symptoms of tetanus usually appear around 8 days after infection, but may range in onset anywhere from three
days to three weeks after exposure to the bacteria. Tetanus can be prevented with a safe and effective vaccine.
About the Vaccine
Vaccination is the best way to protect against tetanus. The tetanus vaccine is most often combined with the diphtheria
vaccine, called the “Td” booster, since both are needed every 10 years. Because of vaccination there are many fewer
cases of these diseases. Cases are rare in children because most receive the initial vaccination series. People who have
not gotten at least 3 doses of any tetanus and diphtheria vaccine during their lifetime should do so using Td. Immunity
wears off, after a person gets the third dose, a Td dose is needed every 10 years all through life.
The Tetanus vaccine and the combination Td vaccine are very safe and effective. As with any medicine, there are very
small risks that serious problems, such as an allergic reaction or neurologic condition, could occur after getting a vaccine.
However, the potential risks associated with tetanus disease are much greater that the potential risks associated with the
tetanus vaccine. You cannot get tetanus from the vaccine.
Listed below are the possible side effects associated with the vaccine:
 Mild problems, such as soreness, redness, or swelling where the injection was given, should they occur, usually start
within hours to a day or two after vaccination and may last 1 to 2 days. Acetaminophen or ibuprofen (non-aspirin)
may be used to reduce soreness.
 Severe problems, are very rare, can be a serious allergic reaction or deep, aching pain and muscle wasting in upper
arm(s). This starts 2 days to 4 weeks after the injection and may last many months.
 In the case of a serious reaction: 1) call a doctor or get the person to a doctor right away; 2) write down what
happened and the date and time it happened; and 3) ask your doctor, nurse, or health department to file a Vaccine
Adverse Event Report form or call: (800) 338-2382.
Tetanus Information Form F-572
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9/1//2005
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Tetanus Information & Questionnaire
for Employees, Fellows, & Non-compensated Appointees
Institute Requirements
All employees who will have exposure to research animals, either doing research on animals, working where animals are
housed, working in animal biohazard areas or involved with veterinary care or animal husbandry, in the scope of their
work assignment must provide Human Resources with proof of current Tetanus immunization (within the past 10 years).
This protected health information is maintained in a confidential medical file in the Human Resources Department.
This requirement is mandated as part of our approved Occupational Health and Safety Program that is filed with federal
and state regulatory agencies. All employees with exposure to animals as outlined above must comply with this
immunization requirement to maintain their current employment status. LA BioMed will provide immunization at no
charge to any employee who cannot provide documented proof of being immunized within the past 10 years. If you have
any questions, please call Human Resources at (310) 222-3890.
Questionnaire
Have you been vaccinated for Tetanus in the past 10 years?
No – If you answered no, please indicate below how you will provide proof:
I will get a tetanus vaccination from my personal physician prior to working with any animals and send proof of
immunization to Human Resources no later than (date)
(Human Resources will contact you
if not received by this date.)
I prefer Human Resources to provide a tetanus vaccination for me at no charge.
Yes - If you answered yes, please provide the following information:
Date of last vaccination
Documented proof of immunization is attached.
Documented proof of immunization will be provided to Human Resources within 72 hours and prior to working
with any animals.
Documented proof of immunization is on file at County Employee Health Services. I have asked them to send a
copy of my medical record to LA BioMed Human Resources. I understand County Employee Health Services
will not forward this information without my request and approval.
I have read and I understand the statements above.
Employee’s name [please print]
Building No
Room No.
E-mail:
Mail Location
Employee’s signature
Extension No
Date signed
Return the completed and signed form to the Human Resources Department, Building N-12.
Tetanus Information Form F-572
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9/1//2005