In Australia, tetanus immunisation occurs as part of the childhood immunisation schedule and is given in conjunction with pertussis and diphtheria vaccine at 2, 4 and 6 months of age. A dose is now given at 4 years of age, replacing the fourth dose previously given at 18 months.2 In a fully immunised adolescent (four doses in the first 5 years of life), a further booster should be given at 15–19 years of age. A new vaccine containing pertussis vaccine has been recommended for this dose. An additional dose should be given at 50 years if a booster has not been given in the intervening years.2 Booster doses of tetanus vaccine after the age of 8 years of age should be in conjunction with low dose diphtheria toxoid (Tp) because there is reduced tolerance to this component. It was previously recommended that an additional booster be given every 10 years and this is still the case in many countries.10
A study which measured the tetanus antibodies of 10,618 vaccinated people and found that these levels declined with age.10 On this basis the researchers recommended that people receive boosters every 10 years to maintain immunity. Conflicting research contends that primary immunisation confers a long-term benefit and that, even though levels of antitoxin wane, it is still rare for a patient who has been fully immunised in the past to develop tetanus. If they do develop the disease, its course will be milder.11 When reviewing the literature it is difficult to compare compliance with tetanus vaccination guidelines because of the variance in international recommendations. This also leads to confusion amongst clinicians when assessing a patient's need for tetanus prophylaxis following injury.