According to immunization experts, the frequency and severity of local reactions to tetanus vaccines increases with the frequency of vaccine administration (Item 107-4). The local reaction is also more severe when the vaccine is inadvertently administered subcutaneously, which may occur when the needle is too short for the site or the patient is obese.

This is not a contraindication to future vaccine. In fact, the new recommendation by the CDC’s Advisory Committee on Immunization Practices (ACIP) is for at least one dose of tetanus diphtheria acellular pertussis (Tdap) booster (Adacel, Boostrix) in adults. This is in response to increased reports of pertussis in adults and older children and the risk of adults’ spreading the disease to infants too young to be immunized. A five-year interval between tetanus diphtheria (Td) and Tdap is recommended to decrease the risk of local and systemic reactions. However, reports from the American Academy of Pediatrics and ACIP indicate the Tdap vaccine can be administered safely as early as two years after Td in cases of community pertussis outbreak.
—Amy Dunlop, ARNP, Sun Prairie, Wis. (111-21)

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