Neonatal Intensive Care UnitChildren's Hospital


Disclaimer to the On-line Edition
This Manual has been designed for use in the NICU at London Health Sciences Centre (LHSC), London, Ontario, Canada, and represents clinical practice at this institution. The information contained within the Manual may not be applicable to other centres. If users of this Manual are not familiar with a drug, it is recommended that the official monograph be consulted before it is prescribed and administered. Any user of this information is advised that the contributors, Editor and LHSC are not responsible for any errors or omissions, and / or any consequences arising from the use of the information in this Manual.



    Tetanus (lockjaw) is a neurological disease with severe muscular spasms caused by the neurotoxin produced by Clostridium tetani in a contaminated wound. The case fatality rate is approximately 60%. The majority of cases in Canada occur after wounds so trivial that medical attention was not sought.

    Tetanus toxoid is virtually 100% effective in preventing tetanus in fully immunized individuals. However, because tetanus spores are widely distributed throughout the environment and the bacteria are commonly found in the intestinal tracts of humans and animals, routine boosters every 10 years for life are necessary to maintain protective immunity.


    Slight fever, local pain, redness, and/or swelling at the injection sight occasionally occur. Sterile abscesses rarely occur after use of adsorbed vaccines containing tetanus toxoid, most often because of inadvertent subcutaneous rather than intramuscular injection.

    Severe local reactions, with marked swelling, redness, pain and tenderness, usually accompanied by fever, malaise, and myalgia may occur in persons who have received an excessive number of boosters of tetanus toxoid.


    Convulsions compatible with simple febrile seizures may rarely occur after tetanus toxoid in association with high fever. Such convulsions are not associated with brain damage or an increased risk of subsequent epilepsy.

    Systemic allergic reactions (anaphylaxis, urticaria, bronchospasm, laryngospasm, angioneurotic edema) are rare.


    Fever greater than 40.5oC; convulsions; or system allergic reactions occurring within 72 hours of vaccination. Other neurologic events occurring within 15 days of vaccination.

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