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Routine tetanus and diphtheria immunisation schedules

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SCHEDULE	CHILDREN	CHILDREN AGED TEN YEARS AND OVER AND ADULTS
Primary course	3 doses of vaccine (usually as diphtheria, tetanus, acellular pertussis, inactivated polio, HIb and Hep B) at 2,3 and 4 months of age	3 doses of vaccine each one month apart Diphtheria, tetanus and inactivated polio (Td/IPV) is the vaccine recommended for all individuals aged ten years and over (2) If the primary course is interrupted it should be resumed but not repeated, allowing an interval of one month between the remaining doses.
4th dose	at least 3 years after the primary course (normally between three and a half years and five years of age), usually pre-school entry (as diphtheria, tetanus, acellular pertussis, inactivated polio) When primary vaccination has been delayed, this first booster dose may be given at the scheduled visit provided it is one year since the third primary dose. This will re-establish the child on the routine schedule. DTaP/IPV or dTaP/IPV should be used in this age group. Td/IPV should not be used routinely for this purpose in this age group because it has been shown not to give equivalent diphtheria antitoxin response when compared with other recommended preparations (2)	Individuals aged ten years and over who have only had three doses of a tetanus-containing vaccine with the last dose at least five years ago, should receive the first tetanus booster combined with diphtheria and polio vaccines (Td/IPV) (2)
5th dose	aged 13-18 years before leaving school (as diphtheria, tetanus, and inactivated oral polio vaccine -Td/IPV)	The second booster dose of Td/IPV should be given to all individuals ideally ten years after the first booster dose.

a full course of tetanus and diphtheria vaccines consists of 5 doses as in the table above
older adults may be unimmunised and at particular risk. Opportunities should be taken to check their immunisation status when attending surgery, e.g. for their influenza immunisation, and complete the recommended 5 dose schedule.
for travellers to areas where medical attention may not be accessible should a tetanus prone injury occur and whose last dose of tetanus containing vaccine was more than 10 years previously, a booster dose of Td/IPV should be given, even if the individual has received 5 doses of vaccine previously. This is a precautionary measure in case immunoglobulin is not available to the individual should a tetanus prone injury occur.

Check uptodate details in the The Green Book before prescribing/administering a vaccination.

Check the Summary of Product Characteristics (SPC) before prescribing/administering a vaccine.

Reference:

Department of Health (August 10th 2004). New vaccinations for the childhood immunisation programme. PL/CMO/2004/3, PL/CNO/2004/2, PL/CPHO/2004/3.
Department of Health (April 2019). Tetanus - Green Book Chapter 30..
Update on immunisation issues (August 2002). PL/CMO/2002/4,PL/CNO/2002/4,PL/CPHO/2002/2.
https://www.nhs.uk/conditions/vaccinations/6-in-1-infant-vaccine/ (Accessed 26/4/19)

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