Tetanus and diphtheria are two preventable diseases. And still, they surface years after childhood vaccinations. As antibody levels decline over time, especially against diphtheria, could the introduction of the Td vaccine signal a crucial point in closing this long-overlooked gap in adult vaccination and protection?
According to the World Health Organization (WHO), maternal and neonatal tetanus has declined significantly over the past two decades. But thousands of people still die from the disease each year, with newborns being especially at risk, particularly in low- and middle-income countries. Diphtheria also continues to cause outbreaks in areas where immunity wanes or vaccine coverage is insufficient.
Fading immunity
India has made progress through Universal Immunisation Programme (UIP): widespread childhood immunisation with DPT vaccines has substantially reduced the incidence of both tetanus and diphtheria. However, immunity especially against diphtheria declines over time without booster doses.
Recognising this, the WHO in 2006 recommended that countries replace the Tetanus Toxoid (TT) vaccine with the combined Tetanus and adult Diphtheria (Td) vaccine. This recommendation was reaffirmed in the WHO Tetanus Vaccine Position Paper (2017) and by the Strategic Advisory Group of Experts (SAGE). India’s National Technical Advisory Group on Immunization (NTAGI) has also endorsed this transition across age groups, including pregnant women.
Earlier this week, Union Health Minister J.P. Nadda launched the Td vaccine at the Central Research Institute, Kasauli, Himachal Pradesh. The CRI, functioning under the Directorate General of Health Services since 1905, will supply 55 lakh doses to the UIP by April, with production expected to increase in subsequent years.
The science behind Td
Tetanus causes painful muscle stiffness and spasms and can lead to breathing difficulties and death. Diphtheria can result in airway obstruction, heart failure, paralysis and fatal complications. The Td vaccine combines purified tetanus toxoid and reduced-dose diphtheria toxoid, adsorbed onto aluminium phosphate as an adjuvant.
The shift from TT to Td can ensure dual protection. Unlike TT, which protects only against tetanus, Td also boosts waning immunity against diphtheria, a disease that can resurface in adolescents and adults if antibody levels fall.
The vaccine introduction can also strengthen domestic manufacturing capacity. The CRI completed developmental studies, secured regulatory approvals including marketing authorisation, and initiated commercial manufacturing before releasing.
Why deaths despite vaccines
“Despite having effective vaccines, tetanus deaths still occur due to low vaccination coverage in adults, waning immunity without boosters, and poor wound care,” says Madhumitha R, senior consultant in infectious diseases and infection control at MGM Healthcare, Chennai.
Adult booster coverage in India remains limited. While pregnant women routinely receive tetanus-containing vaccines under the UIP, non-pregnant adults often do not. Immunity against tetanus weakens after about 10 years without a booster. Studies suggest that a significant proportion of adults may remain susceptible.
Hari Prasad S., consultant in emergency medicine and critical care at SRM Global Hospitals, Chennai, notes that tetanus is often wrongly perceived as a childhood disease. “Many adults believe early vaccines provide lifelong protection. Preventive healthcare is not routinely prioritised in adulthood,” he says.
High-risk groups include agricultural workers, construction workers, daily wage labourers, migrant populations, and the elderly who cannot recall their last booster dose.
Doctors continue to see preventable cases. Dr. Madhumitha recounts a recent case of a 45-year-old migrant worker who developed lockjaw after a minor nail puncture. He had received childhood vaccines but no adult boosters and had delayed proper wound cleaning. Dr. Hari Prasad describes patients arriving in emergency departments with severe spasms, breathing difficulties, and autonomic instability conditions that require intensive care and could have been prevented through timely vaccination and wound management.
Prevention
Delayed or poor wound care is a major cause of tetanus. Wounds like punctures, animal bites, or injuries contaminated with soil should be cleaned immediately, and sometimes need medical care and removal of damaged tissue. Experts stress that antibiotics alone do not prevent tetanus; a booster dose is necessary if vaccination is outdated. They also emphasise misconceptions such as tetanus occurring only from rusty nails or home remedies being sufficient continue to delay care. Proper intramuscular administration in the deltoid muscle is also critical to ensure optimal vaccine efficacy.
Experts emphasise integrating Td boosters every 10 years into routine adult health checks, workplace vaccination drives for high-risk occupations, digital reminder systems, and training healthcare workers to assess tetanus risk in all wound cases.
Published – February 24, 2026 07:07 pm IST