Abstract:
Since 2009 there have been 11 cases of tetanus in New Zealand to 2011 and at least one case in 2012 (2012 data not yet available). No cases occurred in persons who were known to have received a primary course of tetanus vaccine. No safety concerns have been raised for the tetanus toxoid combination vaccines in any groups studied including premature infants. The frequency and severity of local reactions increases with age and additional doses of vaccine. DTaP combination vaccines have been demonstrated to be safe when co-administered with routine vaccines in infants, toddlers and children. Tdap has a safety profile similar to Td. Both vaccines are generally well tolerated and Tdap vaccine has been demonstrated to be safe when co-administered with trivalent inactivated influenza vaccine in adults. Tetanus vaccines are extremely immunogenic and data continues to support the immunogenicity in many groups including premature and low birth weight infants and older adults. There is some evidence that co-administration with Td and tetanus immunoglobulin can reduce the early GMT to the vaccine but this is unlikely to be clinically relevant. Co-administration of tetanus vaccines with other vaccines including MMRV has been demonstrated to be both safe and immunogenic. Vaccine options for the prevention of tetanus disease in infants, children and adolescents in New Zealand include combination vaccines that include DTaP for children up to the age of seven years and the lower strength Td in combination with aP (Tdap) for those seven years and older, adults and the elderly. The tetanus toxoid appears to be immunogenic and safe in all internationally studies of combination vaccines. Tdap has been demonstrated to be safe, immunogenic for the tetanus toxoid antigen and comparable to Td when administered to adults ≥65 years of age and is also expected to be comparable to Td in adolescents and adults ≤64 years of age. DTaP combination vaccines can be administered as a priming course of three vaccinations in the first year of life or as a primary course of two vaccinations plus a booster vaccination in the first year of life. A reduced-antigen content Tdap vaccine can be offered to toddlers and children up to nine years of age as a fourth/booster vaccination. A single Tdap vaccination can be used for the first catch-up vaccination for partially vaccinated or unvaccinated children aged 7 – 10 years of age. Tdap can be administered to adults, including pregnant women and adults ≥65 years of age. Tdap vaccine is an acceptable alternative to Td for the first tetanus toxoid catch-up vaccination and for tetanus prophylaxis when an individual has a tetanus-prone wound. No minimum interval is required between administration of Tdap and a previous Td vaccination. Australia is considering increasing the upper age limit for administration of full strength DTaP vaccines to the 10th birthday. The U.K. already recommends this upper age limit.