Tetanus Update for students in high risk courses.
Standard Operating Procedure
Purpose: To establish policy and standard procedure with the goal of ensuring that all students engaged
in course-related activities which place them at high risk for developing tetanus be 1) advised of this risk,
2) offered vaccination (at student’s expense), if vaccination is not current, and 3) document student’s
refusal to undergo vaccination, if such an election is made, following full disclosure of the risks and
benefits of vaccination vs. non vaccination.
Rationale: Tetanus is a potentially lethal condition which develops as a result of infection with the
anaerobic pathogen, Clostridium tetani. The organism and its spores are present in soil, and are very
prevalent in the manure and organic matter rich soils found on farms, stream beds etc. Injuries resulting
in abrasions, lacerations, and puncture wounds are prone to tetanus if contaminated with spore bearing
soil or dust. The tetanus toxin is a neuromuscular toxin; it targets neuronal synapses in the spinal cord,
where it blocks inhibitory neurons and triggers uncontrolled contractions of voluntary muscles
precipitated by any external stimulus; when muscles of respiration become involved, asphyxiation and
death results. The condition may be mild, such that the patient recovers after a two week illness without
any sequelae, or severe and associated with complications, perhaps resulting in death.
The best protection against the development of tetanus is vaccination. Circulating antibodies produced
against tetanus toxoid conjugated with diphtheria toxoid in the vaccine, dT, provide protection against
the neurotoxin produced by all strains of C. tetani. Following a three step initial (primary) immunization
with dT, a booster every ten (10) years is recommended to maintain immunity. For “dirty” wounds,
however, and farm and field injuries are considered “dirty”, a tetanus booster within the last five (5)
years is advised.
Recommendations: All students expected to physically participate in any course related activity which
might place them at a high risk for tetanus producing injuries should be advised of this risk, and the
availability of protective vaccines through a) Student Health Services, b) the student’s own Primary Care
provider’s office, or c) the local Health Department, should be discussed. The benefits/risks of
vaccination vs. non-vaccination should also be discussed, either by the instructor or his designee, and
students should be encouraged to discuss the subject with their own health care provider.
The benefits of vaccination are the prevention of Tetanus and its potential complications, including
disability and death. The adverse effects of vaccination with tetanus toxoid (normally conjugated with
diphtheria toxoid) are vaccine reactions, which can be local and / or systemic. Local reactions include
soreness, redness and swelling at the injection site; typically mild, but may at times be moderate, and on
occasion severe. Systemic reactions include fever (usually low grade), malaise, body aches (usually mild).
These typically last a couple of days, and can be treated with cold packs to the injection site every three
to four hours for twenty minutes each, and Ibuprofen or Tylenol orally. More severe systemic reactions
are rare, but have been seen. These include anaphylactic reactions, with hives, generalized swelling,
including swelling of the face, mouth, tongue, and throat, wheezing, chest tightness, shortness of
breath, drop in blood pressure, and shock. This is a life threatening event, and requires immediate
medical attention. Those allergic to Thimerosal (a mercury derivative introduced in trace quantities in
the vaccine manufacturing process) should not take the vaccine.
Non-vaccination avoids the adverse reactions of the vaccine, but leaves one open to Tetanus. The
disease can be mild, moderate, or severe, and potentially fatal.
The following form should be used to document the process, and retained in the student’s record for
the duration dictated by our archivist (typically 10 years since last enrolled). If close contact with animals
is expected, whether in the field, on the farm, or in the lab, the Animal Worker Questionnaire should
also be completed by every student taking the course, and retained as part of the student record for the
duration recommended by our archivist. When the retention period expires, records may be purged.
Since these records may be construed as medical or “Protected Health Information”, it is best to store
them in such a way that privacy is preserved.
Form:
I, ___________________, understand that as a student enrolled in ________________________, taught
Name of Student
Name of Course
by __________________, for the period_____________, I will be involved in activities which might place
Name of Instructor
From - To
me at high risk for developing tetanus (lock jaw), a potentially fatal condition. I have been informed that
a complete tetanus series of three (3) injections and a booster within the last five (5) years is highly
recommended as protection against this disease. I understand that I may obtain the tetanus vaccine
through my own health care provider or at the local health department, and that it is also available at
the Student Health Services, where I may obtain it at cost.
I have had a chance to discuss the benefits and risks of vaccination vs. non-vaccination with my
instructor / health care provider, and have elected to do the following:
a) Take the tetanus vaccine: _________(date of administration)_________________
b) Not take the tetanus vaccine: ______
Reason for not taking vaccine:
i) I am up to date on my tetanus shot _______________
Date of last booster _______________
ii) I have been advised by my health care provider that I should not take the
tetanus vaccine and I am aware of the benefits and risks of this decision._________
iii) Personal reasons other than those listed above___________; I realize the risks
associated with not being protected against tetanus while engaging in tetanus
prone activities.
Name of Student: _________________________Signature of Student: ________________________
Date: ________________________