Tetanus vaccination and travel: clinical and practical considerations

Tetanus is now rare in the UK thanks to the national immunisation programme, but travellers may face increased risks in areas with limited healthcare. General practice nurses are vital in ensuring travellers receive proper tetanus protection and navigate NHS vaccine provision complexities.

Background

Tetanus, caused by Clostridium tetani, is found worldwide, especially in soil and animal waste. It enters the body through wounds and causes serious symptoms like muscle rigidity and spasms. Vaccination since the 1940s has greatly reduced cases, though most UK infections now occur in unvaccinated adults.

Epidemiology in England

Six cases were reported in 2024, with two deaths. Most had unknown or incomplete vaccination records, highlighting the need for accurate recordkeeping.

Routine Immunisation Schedule

Five doses of tetanus-containing vaccines provide lifelong protection, offered free through the NHS.

Tetanus Risk in Travellers

Although five doses provide long-term protection, additional considerations apply to individuals travelling abroad. Travellers may need an extra booster if visiting regions without adequate medical care (e.g. access to immunoglobulin), especially if their last dose was over ten years ago. For frequent travel or higher-risk activities, boosters can be repeated every ten years based on a careful pre-travel assessment of clinical need.

Vaccine Availability and Charging

Standalone tetanus vaccines aren’t available; Revaxis (tetanus, diphtheria, polio) is used instead and must be provided by NHS GP practices at no charge for travel. This is because poliomyelitis vaccination is funded by the NHS as a public health intervention, and tetanus is only available in a combined vaccine containing polio and diphtheria.

As a result, when Revaxis is administered, all components of the vaccine must be provided on the NHS, regardless of the travel context. GP practices are therefore unable to offer this vaccination privately.

Practices procure the vaccine directly or via NHS prescriptions. In this situation, the pharmacy dispenses the vaccine and the patient returns to the surgery for administration. Unless exempt, the patient must pay the standard NHS prescription charge. This approach is generally discouraged as it places the cold chain at risk, requires multiple appointments and is inconvenient for both patients and practices.

Polio Booster Requirements

In certain travel scenarios, especially to areas with polio outbreaks, additional poliovirus vaccination may be required and documented.

Pregnancy

Pregnant women are routinely offered pertussis-containing vaccines. Currently recommended vaccines include Tdap formulations, such as Adacel, which contains not less than 20 International Units (IU) of tetanus toxoid, equivalent to the tetanus content in Revaxis. If a pregnant woman has received Adacel as part of the national pertussis programme and later attends for travel advice, the tetanus component of that vaccine can be counted as valid tetanus protection for travel purposes; careful assessment avoids unnecessary repeat vaccination.

Wound Management

Tetanus is a notifiable disease.

Tetanus-prone wounds include contaminated punctures, animal bites, burns, and compound fractures. High-risk wounds involve heavy contamination and delayed surgery. Prompt and thorough wound cleansing is essential.

Individuals at greatest risk are those who completed a full course of tetanus vaccine more than ten years ago, children aged 5-10 years who have yet to complete the full five doses of tetanus immunisation, and those who have not received an adequate priming course of tetanus vaccine.

In situations such as these, treatment may include tetanus immunoglobulin, injected intramuscularly (IM-TIG), together with a booster dose of vaccine.It is important that either IM-TIG administration or active boosting occurs promptly following an exposure.

Conclusion

Understanding when additional boosters are indicated, recognising valid tetanus protection from pregnancy vaccination, and navigating NHS funding arrangements are essential to safe and compliant practice.

By applying current guidance and maintaining awareness of evolving recommendations, general practice nurses play a crucial role in preventing this serious but avoidable disease.

Resources

• Chiodini J. Tetanus vaccination and travel: clinical and practical considerations. Practice Nurse 2026;56(2):22-25
• NaTHNaC Tetanus https://travelhealthpro.org.uk/disease/168/tetanus
• UKHSA Collection, Tetanus: guidance, data and analysis https://www.gov.uk/government/collections/tetanus-guidance-data-and-analysis
• NHS website https://www.nhs.uk/conditions/tetanus/