1 May 2026Vaccines, immunoglobulins and antisera
Tetanus-diphtheria vaccine (Td)
Td vaccine guidance for wound management, pregnancy, childbearing age, and booster protection after primary vaccination.
This guide page is for structured reference only and does not replace a clinician, pharmacist, or emergency review. Dose choice, route choice, interactions, and safety decisions still need professional judgment.
Indications
- Prevention of tetanus in wound management.
- Prevention of tetanus and diphtheria in pregnant women or women of childbearing age.
- Prevention of tetanus and diphtheria in children over 4 years and adolescents as a booster after complete primary vaccination.
Composition, forms, route of administration
- Bivalent vaccine combining tetanus toxoid and diphtheria toxoid, containing a reduced dose of diphtheria toxoid.
- Suspension for injection in multidose vial, for IM injection into the deltoid muscle.
Dose and vaccination schedule
Child and adult: 0.5 ml per dose.
Prevention of tetanus in wound management
- For minor clean wounds with complete vaccination less than 10 years ago: no Td dose is needed.
- For minor clean wounds with complete vaccination more than 10 years ago: 1 Td booster dose.
- For other wounds with complete vaccination less than 5 years ago: no Td dose is needed.
- For other wounds with complete vaccination 5 to 10 years ago or more than 10 years ago: 1 Td booster dose.
- For incomplete vaccination, no vaccination, or unknown status: initiate or complete tetanus vaccination, and for wounds other than minor clean wounds, administer tetanus immunoglobulin.
- Initiation schedule: 2 doses 4 weeks apart then 3 additional doses according to the pregnancy and childbearing-age schedule below.
Prevention of tetanus in pregnant women and women of childbearing age
- 5 doses according to the following schedule: Td1 on first contact or as soon as possible during pregnancy. Td2 at least 4 weeks after Td1. Td3 6 months to 1 year after Td2 or during the following pregnancy. Td4 1 to 5 years after Td3 or during the following pregnancy. Td5 1 to 10 years after Td4 or during the following pregnancy.
- In pregnant women, administer at least 2 doses before delivery: the first as soon as possible during pregnancy and the second at least 4 weeks after the first and at least 2 weeks before the due date. After delivery, continue until all 5 doses have been administered.
Prevention of tetanus in children over 4 years
- Booster dose between 4 and 7 years then between 9 and 15 years, after complete primary vaccination and one booster between 12 and 23 months.
Contra-indications, adverse effects, precautions
- Do not administer in the event of allergic reactions after a previous dose of tetanus or diphtheria vaccine.
- Vaccination should be postponed in the event of severe acute febrile illness; minor infections are not contra-indications.
- May cause mild local reactions such as redness or pain at the injection site, fever, pain, malaise, and rarely anaphylactic reactions.
- If administered simultaneously with other vaccines, use different syringes and injection sites.
- Pregnancy and breast-feeding: no contra-indication.
- The monovalent tetanus vaccine is used in certain national protocols. Preferably use the conjugate tetanus-diphtheria vaccine for prevention of tetanus in children over 7 years, adolescents, and adults.
- Tetanus vaccination in pregnant women and women of childbearing age protects neonates from tetanus.
Source
MSF Essential drugs practical guidelines (January 2026)
This page reproduces the structured reference information for this batch while leaving out the Storage and Remarks sections.
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