Tetanus Vaccine and Travel
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- The routine schedule for tetanus immunisation for life in the UK is to have 5 doses as per the UK childhood immunisation programme. This is always available to NHS patients on the NHS so there is no charge.
- If a traveller is visiting a country abroad where treatment for a tetanus prone wound may not be feasible, then it is advised to give another tetanus containing vaccine prior to departure of this travel trip if there has been an interval of 10 years minimum since the last tetanus vaccine administration.
- We would continue to provide this additional tetanus at 10 yearly intervals if the patient was travelling and if, after the travel risk assessment, there was thought to be a need.
- In the UK, such protection is only currently available in the vaccine ‘Revaxis’ which is combined tetanus, diphtheria and inactivated polio vaccine.
What are the financial arrangements for tetanus provided for travel abroad?
In an NHS setting (e.g. an NHS GP surgery) if tetanus is subsequently give for travel at a ten yearly interval as described above, this must also be provided as an NHS provision. A GP surgery cannot charge for it. This is because we provide poliomyelitis on the NHS* (initially set up for the public health risk) and because tetanus is only available in the combined vaccine of tetanus, polio and diphtheria (revaxis) these other two disease protections must be given on the NHS as well.
For more details on the general topic of charging for travel vaccines see FAQ no. 2
How would this tetanus vaccine be obtained?
- You are not allowed to use the ImmForm stock for the purpose of travel (unless you are catching the traveller up on completing their five doses of tetanus as part of the National programme)
- The most common way revaxis is obtained for travel purposes is by the surgery purchasing in the vaccine (if working in England) and then claiming it back
- Claiming is done via the NHS Prescription Service which is provided by the NHS Business Services Authority. Historically we’ve called this the Prescription Pricing Authority (PPA)
- Occasionally some surgeries chose not to buy in the vaccine and give the patient an NHS prescription instead. This means the pharmacy will order it in, supply it to the patient who then takes it back to the surgery for administration. In this instance, unless exempt, the traveller will need to pay the NHS Prescription fee. This method is not favoured as it puts the cold chain at risk, is time consuming for the patient and also requires two surgery appointments which is a waste of time.
*Please note at the current time, there are occasions in England when polio containing vaccine is not provided on the NHS for certain travellers going to an area in the world where there are regulations in place as part of the Public Health Emergency of International Concern (PHEIC) for the prevention of spread of polio – please see this link for more information.
Further information regarding routine schedule for tetanus and then further vaccine given for travel purposes can be found in Chapter 30 the Green Book pages 370-373. Details about ordering these vaccines appropriately is found in Chapter 3 of the Green Book page 20.
Pregnancy and current tetanus containing vaccines
- A pregnant women is currently recommended to receive a vaccine for protection against pertussis at 16 weeks in the national schedule. The vaccines advised on the immunisation chart are Boostrix-IPV and Repevax. See the current patient leaflet and poster.
- In the qualitative and quantitative composition (item no. 2) in the SPCs of both these vaccines it says the content of tetanus toxoid is not less than 20 International Units (IU). This is the same content as in a Revaxis.
- I would therefore conclude that if a pregnant women had received vaccination for pertussis and then at a date further on, attended for travel advice, this dose of tetanus contained within the boostrix-IPV or repevax would also count as protection for the tetanus needed for travel purpose.
Treatment of a tetanus prone wound
The guidance for the management of patients with tetanus prone wounds was published in 2006 in Chapter 30 of the Green Book, however in July 2018 Public Health England published an update to their guidance as an interim measure which can be found here. This was then replaced by the fully published guidance document Tetanus Guidance on the management of suspected tetanus cases and on the assessment and management of tetanus prone wounds on 9th November 2018. The Green Book was then also updated in November 2018.
Six cases of tetanus were reported in England from January to December 2012, there were no reported cases from Wales. All the cases were among adults aged 30 – 82 years. Two deaths were reported in women over the age of 64 years. More details are available in the Health Protection Report Volume 7, no 22, published 31st May 2013. See page 30 of this document here
Details from Public Health England of tetanus cases by age group and year of onset in England and Wales 1984-2014 can be found here
Further resources for information about tetanus