All You Need To Know About Tetanus Vaccination During Pregnancy

The importance of vaccines or injections are not unknown to us as they have been shielding humans for decades. They significantly reduce the risk of illness, complications, and even death caused by various pathogens. By stimulating the immune system to develop immunity without causing illness, vaccines help create herd immunity. They have proven to be instrumental in controlling and eradicating diseases. Vaccines are essential tools in public health, pivotal for preventing the spread of infectious diseases and protecting individuals across all age groups including pregnant women. 

Importance of Vaccination During Pregnancy 

During pregnancy, prospective parents take numerous precautionary measures to ensure the health and well-being of both the mother and the unborn child. Vaccination is considered integral among these precautions. Vaccinating pregnant women can provide protection against vaccine-preventable infections for the mother, potentially safeguarding the foetus as well. Additionally, immunisation during pregnancy can directly shield the foetus and newborn by transferring antibodies from the mother to the foetus. Some infections are so severe that they can jeopardise the pregnancy, harm the developing baby, or pose risks even after delivery. Vaccines have the power to prevent these possibilities. 

What is Tetanus Injection? 

Tetanus is among the diseases that can affect pregnant women. It is a life-threatening bacterial infection caused by Clostridium tetani, commonly found in soil. The disease enters the body through open wounds, which can range from minor cuts or scratches to deeper puncture wounds like bites, burns, or ulcers. It can cause convulsions and muscle stiffness. During childbirth, tetanus bacteria can enter the pregnant woman's body through the genital tract, potentially causing uterine tetanus. In newborns, these bacteria can easily infect the site where the umbilical cord is cut and tied, leading to neonatal tetanus. Once inside the body, the bacteria produce a toxin known as tetanospasmin, which enters the bloodstream. This toxin can result in respiratory failure, nervous system disorders, and ultimately death in children if not identified and treated promptly. This underscores the critical importance of preventing and treating tetanus infections, particularly through tetanus vaccine during pregnancy, to protect both mothers and infants from serious health risks. According to the World Health Organisation (WHO), neonatal tetanus claims the lives of more than 2 lakh newborns annually, with nearly all these fatalities occurring in developing countries, while occurrences in developed nations are exceedingly rare.

Tetanus Injection during Pregnancy 

The tetanus vaccine contains non-infectious toxoids, which are considered safe for use during pregnancy. It is administered in many countries including India to prevent neonatal tetanus. In India, the National Immunisation Schedule recommends administering two TT doses in pregnancy to ensure immunity. The first tetanus toxoid dose is advised to be administered as soon as pregnancy is detected. The second dose of the tetanus toxoid vaccine during pregnancy is administered four weeks after the first. If a mother received two doses of tetanus toxoid in her previous pregnancy and becomes pregnant again within three years, only one dose, known as the booster dose, is recommended. Some experts suggest that the second dose of the vaccine should be administered four weeks before the expected date of delivery. Additionally, the World Health Organisation recommends a third vaccine six months after the second dose to ensure protection for at least five years. Following tetanus toxoid vaccination, antibodies produced in the mother are passed to the baby, providing protection for several months after birth. TT vaccination also contributes to reducing the risk of premature birth or delivery. 

Pregnant women should strictly follow their healthcare provider's vaccination schedule rather than choosing to vaccinate against tetanus voluntarily. It is normal to experience pain at the injection site, fever, headache, or mild allergic reactions after vaccination, as this indicates the vaccine is beginning to produce antibodies to protect against infection. These symptoms are typically minor and will resolve on their own without needing medication or topical treatments.

Antibodies against tetanus are usually formed within two weeks after vaccination. If a pregnant woman experiences symptoms like cold extremities, pale skin, diarrhoea, heart palpitations, or difficulty breathing after receiving the second tetanus injection, she should seek immediate medical attention for prompt intervention and treatment.

TDAP Vaccination during Pregnancy 

Another vaccine crucial for pregnant women to prevent illnesses or diseases is the Tdap vaccine. It is a combined vaccine that provides protection against Tetanus, Diphtheria, and Pertussis (Whooping Cough). Whooping cough can pose severe risks to infants. When a mother receives the Tdap vaccine during pregnancy, she can transfer protective antibodies to her newborn, offering crucial protection during the vulnerable early months against Pertussis. Unlike other vaccines, Tdap is recommended for every pregnancy, regardless of prior vaccination history. Sticking to the vaccination schedule, which includes getting the Tdap vaccine, helps protect both individuals and the community, following global health guidelines. The vaccine serves as a replacement for the second dose of TT injection, providing comprehensive protection against Tetanus, Diphtheria, and Pertussis. Administering the Tdap vaccine between 27 to 36 weeks of pregnancy ensures optimal antibody levels for the foetus. This vaccine is pivotal in preventing Pertussis and its potential complications for both the mother and the newborn. 

Pregnant women are often more prone to influenza than non-pregnant women. Pregnancy brings changes to the immune system, heart, and lungs, making pregnant women more susceptible to severe illness, hospitalisations, and even death from influenza. Infection with influenza during pregnancy also increases the risk of serious complications for unborn babies, including premature labour and delivery. Pregnant women in the second and third trimesters are at higher risk of hospitalisation due to influenza. Therefore, it is recommended that all pregnant women receive routine inactivated influenza vaccine during flu season, regardless of the trimester of pregnancy they are in. These vaccines are safe and effective in preventing significant illness and death in pregnant women. Maternal influenza vaccination provides proven benefits in preventing disease for both women and their newborns, making it a crucial measure during pregnancy. Live attenuated influenza vaccine, administered as an intranasal spray, is not recommended for pregnant women due to safety concerns.

How are the vaccines administered?

Vaccination procedures, particularly for Tetanus and Diphtheria protection, adhere to a standard protocol for safety and effectiveness:

1. Screening

Healthcare providers evaluate the pregnant woman's health and vaccination history to determine suitable vaccines and timing.

1. Vaccine Administration

Tetanus Toxoid and Tdap vaccines are usually given through an intramuscular injection in the upper arm.

1. Monitoring

Patients are typically observed briefly after vaccination to check for any immediate adverse reactions.

1. Follow-Up Plan

Some vaccines require multiple doses, and a follow-up schedule is provided to ensure full protection is achieved.

The majority of vaccines administered during pregnancy, such as Tetanus Toxoid, Tdap, and Influenza vaccines, are inactivated and are considered safe for both the mother and the foetus. Live virus vaccines like MMR (Measles, Mumps, Rubella) and chickenpox should not be administered to pregnant individuals. It is advisable to receive these vaccines either before or after pregnancy, depending on individual circumstances. If you are at risk for Hepatitis B, it is recommended to complete the vaccine series before pregnancy to prevent the possibility of transmitting the virus to your baby. The HPV (Human Papillomavirus) vaccine is recommended for women up to the age of 26 who are planning to become pregnant. This vaccine helps prevent cervical cancer and genital warts.

Pregnancy is a sensitive period where certain precautions are crucial. Discussing vaccine safety and toxoids with healthcare professionals is essential. They will provide guidance on which vaccines are recommended and which ones should be avoided to promote a healthy pregnancy and ensure the well-being of both mother and baby. Healthcare providers can assess the pregnant woman's medical history, current health status, and potential risks to determine which vaccines are safe and appropriate. Certain vaccines are recommended at specific times during pregnancy to maximise protection for both the mother and the baby. Doctors can ensure that vaccines are administered correctly and at the optimal time to provide maximum effectiveness in preventing infections. Each pregnancy is unique, and healthcare providers can provide personalised recommendations based on any specific risks or considerations. Doctors stay informed about the latest vaccine recommendations and safety guidelines, ensuring that pregnant women receive the most current and accurate information. 

Frequently Asked Questions

1. Is tetanus vaccine during pregnancy allowed?

Tetanus vaccine during pregnancy is recommended. Women are advised to receive at least two doses of TT injection, with a minimum interval of 28 days between doses. If a woman's immunisation history is unknown or she has not been vaccinated previously, two doses should be administered before delivery, ensuring the second dose is completed at least four weeks prior to delivery.

2. Can the tetanus diphtheria pertussis vaccine during pregnancy be administered? 

It is advised that women receive a single dose of Tdap during each pregnancy, ideally administered between 27 and 36 weeks of gestation.

3. Which vaccines are unsafe for pregnant women?

Human papillomavirus (HPV) vaccine, measles, mumps, and rubella (MMR) vaccine, live influenza vaccine (nasal flu vaccine), varicella (chicken pox) vaccine and certain travel vaccines like yellow fever, typhoid fever, and Japanese encephalitis are unsafe for pregnant women. 

Sources: 

Vaccination during pregnancy: Today's need in India - PMC 

Get the Whooping Cough Vaccine During Each Pregnancy | CDC

The Importance of Vaccines in All Stages of Lif