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Who is at highest risk for tetanus vaccine complications?

Updated April 06, 2024

vaccine who should not get

There is a gap in medical knowledge in terms of doctors being able to predict who will have an adverse reaction to tetanus vaccination, and who will not.

Persons with a history of Guillain-Barre Syndrome (GBS) within six weeks of receiving a tetanus containing vaccine may be at an increased risk of recurrent GBS illness following tetanus vaccination.                       

Anyone who has experienced an Arthus-like reaction (severe painful swelling of the injected arm) following a previous dose of tetanus toxoid vaccine are also considered to be at a greater risk of a recurrent reaction and should not be vaccinated with tetanus toxoid vaccine more frequently than every 10 years. 

Infants born prematurely have been noted to experience apnea following intramuscular vaccination, placing them at higher risk for complications following vaccination. DTaP and DT vaccine product inserts state that the decision to vaccinate an infant born prematurely should take into consideration health status and the possible risks and potential benefits of vaccination.           

Residual milk allergens may persist following the manufacturing of DTaP and Tdap vaccines. While the CDC’s Advisory Committee on Immunization Practices (ACIP) does not consider a milk allergy to be a contraindication to vaccination and recommends both DTaP and Tdap vaccines for persons with known milk allergies, it does, however, strongly advise the monitoring of milk allergic patients due to the potential risk of anaphylaxis.  

Pre-licensing clinical studies of Adacel vaccine (Tdap) reported that when the vaccine was administered concomitantly with the Hepatitis B vaccine, there were an increase in reports of redness and swelling at the injection site and an increase of reports of swollen joints and body aches. Additionally, when Adacel was administered with the trivalent inactivated influenza vaccine (TIV), Fluzone, pain at the injection site was noted to be statistically higher when compared to the separate administration of Adacel vaccine. Rates of joint pain and swelling were also noted to be higher when Adacel was administered concurrently with Fluzone. As a result, persons who receive simultaneous vaccinations with one or more vaccines may be at a higher risk for adverse events. 

The TENIVAC (Td) vaccine product insert states that administering the vaccine more frequently than prescribed may result in the increased incidence and severity of adverse reactions. 

The Institute of Medicine (IOM) has acknowledged that there is individual susceptibility to vaccine reactions for genetic, biological and environmental reasons, but that vaccine providers cannot accurately predict prior to a vaccine’s administration who will suffer complications, injury or death from vaccination.  However, a person who has previously had a serious reaction to a vaccination or is acutely or chronically ill should become informed about all potential risks associated with vaccination and discuss any concerns with a trusted health care professional before receiving a DTaP/Tdap/Td vaccine or any other vaccine.

IMPORTANT NOTE: NVIC encourages you to become fully informed about Tetanus and the Tetanus vaccine by reading all sections in the Table of Contents , which contain many links and resources such as the manufacturer product information inserts, and to speak with one or more trusted health care professionals before making a vaccination decision for yourself or your child. This information is for educational purposes only and is not intended as medical advice.


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