Tetanus and Diphtheria Toxoids (adult strength, Td)

A to Z Drug Facts

 Action Induces antibodies against toxins made by Corynebacterium diphtheriae and Clostridium tetani.

 Indications Achievement of active immunity against diphtheria and tetanus. Tetanus and diphtheria toxoids for adult use (Td) is preferred agent for immunizing most adults and children after age 7.

 Contraindications Immediate hypersensitivity to product, to thimerosal or to any components; during immunosuppression, acute respiratory infection (except for emergency booster recall doses).

 Route/Dosage

Primary Immunizing Series

ADULTS & CHILDREN ³ 7 YR: IM A total of 3 doses (0.5 ml each): 1 dose now followed by 1 dose 4–8 wk later and then 1 dose 6–12 mo after first dose.

Booster Doses

ADULTS: IM 0.5 ml at 10-yr intervals throughout life to maintain immunity.

 Interactions None well documented.

 Lab Test Interferences None well documented.

 Adverse Reactions Local: Small amount of erythema, induration, pain, tenderness, heat and edema surrounding injection site, persisting for few days, is not unusual. Nodule may be palpable at injection site for few weeks. Allow such nodules to recede spontaneously. Sterile abscess and SC atrophy occur rarely. Adverse reactions often associated with multiple prior booster doses may be manifested 2 to > 12 hr after administration by erythema, boggy edema, pruritus, lymphadenopathy and induration surrounding point of injection. Pain and tenderness, if present, are usually not primary complaints. Systemic: Transient low-grade fever (temperatures > 38°C [100°F]) following Td administration are unusual, chills, malaise, generalized aches and pains, headaches, flushing, generalized urticaria or pruritus, tachycardia, anaphylaxis, hypotension, neurologic complications. Persons developing significant adverse reactions should not be given Td, even emergency doses, more frequently than every 10 years.

 Precautions

Pregnancy: Category C. Lactation: Undetermined. Anticoagulant therapy: As with all IM injections, give drug with caution to persons receiving anticoagulant therapy. Susceptibility: Like all inactivated vaccines, administration of Td to persons receiving immunosuppressant drugs, including high-dose corticosteroids or radiation therapy may result in insufficient response to immunization. They may remain susceptible despite immunization.

 Administration/Storage

• Shake vial before withdrawing dose.
• Give IM only, do not administer IV or SC.
• Inject into deltoid muscle. Take care to avoid major peripheral nerve trunks.
• Several routine vaccines may safely and effectively be administered simultaneously at separate injection sites (eg, measles-mumps-rubella, oral polio vaccine, inactivated poliomyelitis vaccine, Haemophilus influenzae type b, hepatitis B, influenza). Authorities recommend simultaneous immunization at separate sites as indicated by age or health risk.
• Document in patient's medical record manufacturer name and lot number, date of administration, and name, address and title of person administering vaccine.
• Report adverse events to Vaccine Adverse Event Reporting System (VAERS), 1–800-822–7967.
• Store under refrigeration.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• Use caution when administering to patient on anticoagulant therapy.
• Observe patient after injection for symptoms of anaphylaxis. Have 1:1000 epinephrine on hand.
• Monitor for significant side effects, including tachycardia, hypotension, neurologic complications, fever, chills, generalized arthralgias, headache and flushing.

 Patient/Family Education

• Explain that pain, edema or pruritus may be experienced at site of injection.
• Stress to family that patient must receive all 3 doses for immunization to be effective.
• Explain need for booster at 10-yr intervals.

Books@Ovid
Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts