As part of our Vaccine Engagement Day initiative, we will be posting a series of blogs exploring the impact vaccines have had in a number of areas. In our second post of the series, we are exploring the tetanus vaccine.
Imagine a world where a small scratch or a scrape could lead to deadly muscle spasms, paralysis, and even death. Before the widespread use of the tetanus vaccine, introduced in 1961, this was a real risk for many. Tetanus occurs when tetanus toxin – produced by the bacterium Clostridium tetani – enters the body through a wound or a scratch. Tetanus is a life-threatening condition with symptoms ranging from painful muscle spasms and lockjaw, to seizures and breathing problems.
By the 1970s, tetanus in UK children under 15 had almost disappeared, and a 2024 study has shown that the tetanus vaccine has averted 27.9 million deaths between 1974–2024. To put this into context, this is slightly more than the entire population of Australia (27,204,809 as of June 2024). This translates to 1.4 billion years of life saved, with tetanus being the most deadly to infants and the elderly.
The history of the tetanus vaccine in the UK
Prior to the vaccine’s development in 1931, tetanus antiserum was used to treat wounded British soldiers during World War I in an effort to prevent the disease. By 1939, the tetanus vaccine was widely administered to the British Army, with tetanus cases during World War II 1/25 of that in the first World War.
Despite this initial success of tetanus vaccination during the war, tetanus mortality remained high among infants, children and people above the age of 50. It was therefore suggested that vaccination of the general population should be considered, particularly for children. From 1961, the tetanus vaccine was included as part of the UK’s primary immunisation for infants. This contributed to there being no cases of tetanus in the UK in infants or children under the age of 5 between 1985 and 2017. Tetanus cases are now extremely rare in the UK.
How does the tetanus vaccine work?
The tetanus vaccine contains tetanus toxoid, which is produced by the tetanus causing bacteria. However, it does not contain the live bacteria meaning that it cannot cause the disease it is protecting against. Instead, it is a way to train your immune system to recognise a tetanus infection and mount an immune response quickly without actually being infected.
The vaccine is given as part of the routine NHS vaccination schedule with three primary doses at 8, 12 and 16 weeks of age as part of the 6-in-1 vaccine, and then booster doses as part of the pre-school 4-in-1 and teenage 3-in-1 vaccinations. The tetanus vaccine is given alongside those for other serious illnesses to provide protection from a young age and maintain it into adulthood.
In 2023/2024, 92.4% of children in England received their first three doses of the tetanus vaccine by the age of 2. While across the UK, uptake of these vaccines are high, they do not reach the World Health Organisation recommended level of 95%. In fact, in recent years uptake has been decreasing. This means that it’s important that we keep communicating the facts around vaccination against tetanus and why it’s so important for health.
The five tetanus vaccine doses have been shown to maintain long-term protection against tetanus. Boosters help to maintain immunity and prevent antibody levels falling below the protective level. These are also given when an individual has a tetanus high-risk wound such as those contaminated with soil or manure, if they have received a complete course of tetanus vaccines, or in children aged 5-10 who’ve had a primary course but no booster, alongside a single dose of tetanus immunoglobulin. For individuals who haven’t had a complete course of the tetanus vaccine, a booster is recommended regardless of whether the wound is high-risk or not.
Tetanus around the world
While tetanus is now extremely rare in the UK, this is not the case everywhere, particularly in low-income countries with low immunisation coverage and non-sterile birth practices. While tetanus can affect anyone, it is particularly serious in newborn babies and pregnant women. Globally, it is estimated that the number of newborns that died due to neonatal tetanus in 2018 was reduced by 97% compared with 1988, largely due to efforts to increase immunisation with tetanus vaccines. The Maternal and Neonatal Tetanus Elimination (MNTE) initiative was launched in 1999 with the aim of having less than one neonatal tetanus case per 1,000 births in every district per year. This initiative focuses on supporting the increase of tetanus immunisation among pregnant women, alongside promoting clean birth deliveries, to eventually make avoidable tetanus deaths a thing of the past. Out of the 57 countries considered not to have achieved MNTE in 2000, 10 remain to have not yet achieved MNTE as of December 2024.
A success story in the fight against tetanus
The tetanus vaccine has led to a huge global decrease in the lives lost to tetanus. In countries like the UK, protection from the vaccine means that minor scratches and wounds are unlikely to develop into serious illness from tetanus. Maintaining these high levels of protection are crucial for this to continue, as tetanus causing bacteria are still present in the environment. As more countries work towards eliminating the disease, we can look back on the development of the vaccine as a true vaccine success story.
For more information on how vaccines and booster vaccines work, check out our videos on our website or on YouTube.
By Dr Rebecca Milton
External Affairs Intern
Enjoyed this blog? Read our other blogs in the series:
Celebrate Vaccines: How the HPV vaccine has transformed cervical cancer prevention