VAN BUREN/CASS DISTRICT HEALTH DEPARTMENT
TETANUS - DIPHTHERIA (Td) VACCINATION
STANDING ORDER
INDICATIONS
To prevent tetanus, which is an acute, often fatal, disease caused by an exotoxin produced by
Clostridium tetani.
a.
Td may be administered for individuals 7 years of age and older. DPT, or DT if
pertussis vaccine is contraindicated, may be given for children less than age 7 years
old.
b.
Td is given for wound management if client has less than 3 doses of tetanus toxoid
which includes clean, minor, arid all other wounds.
c.
SUMMARY GUIDE TO TETANUS PROPHYLAXIS IN
ROUTINE WOUND MANAGEMENT, 1991
History or Adsorbed Tetanus
Clean, Minor Wounds
All Other Wounds
Toxoid (doses)
Td
*TIG
Td
*TIG
Unknown or < 3
Yes
No
Yes
Yes

3 or more doses
No
No§
No
No
*
**

§
Tetanus Immune Globulin
Such as, but not limited to, wounds contaminated with dirt, feces, soil, and saliva,
puncture wounds; avulsion; and wounds resulting from missiles, crushing, bums, and
frostbite.
Yes, If > 10 years since last dose.
Yes, if > 5 years since last dose. (More frequent boosters are not needed and
can accentuate side effects.)
Note: Td contains one-third as much diphtheria toxoid as DT.
d.
Recommended at age 11 - 12 years for a routine booster then every 10 years
DOSAGE AND ADMINISTRATION


3 doses of Td is a primary series.
2 doses of 0.5cc of Td IM at least 4 weeks apart; followed by 0.5cc Td vaccine IM 6-12
months after 2nd dose.
Td Vaccination Standing Order, Page 1 of 2
Routine Diphtheria and Tetanus Vaccination Schedule
Summary for Persons > 7 Years of Age
Dose
Primary 1
Primary 2
Primary 3
Booster
Age/Interval
First dose 0.5 cc IM
4-8 weeks after first dose 0.5 cc IM
6-12 months after second dose 0.5 cc IM
Every 10 years after last dose
Product
Td
Td
Td
Td
CONTRAINDICATIONS
a.
Pregnant women in their first trimester
b.
History of severe local reaction (Arthus-type) or fever > 103oF following previous dose
c.
History of neurologic or severe allergic reaction (acute respiratory distress or collapse)
following a previous dose of tetanus toxoid.
d.
Hypersensitivity to thimerosal (mercury derivative).
REFERENCES
1.
Connaught Laboratories Inc. Product Information 6-1996.
U.S.A.
2.
Epidemiology and Prevention of Vaccine Preventable Diseases, Dr. William Atkins,
1998. 2nd printing.
3
CDC US Department of Health and Human Services P.H.S. Atlanta, GA.
DISTRIBUTION
Immunization Manual
John R. Spriegel, M.D., M.P.H.
Medical Director
Rev: 9/17/02
StandingOrders/TdVaccination.doc
Td Vaccination Standing Order, Page 2 of 2
Date
Swiftwater, PA.
18370