Overuse of tetanus toxoid vaccine: a common but under-addressed issue in Nepal

Introduction and importance: Tetanus, though potentially fatal, is preventable with proper vaccination, but high tetanus titers from frequent or higher doses can lead to increased adverse events. In countries like Nepal, where tetanus vaccines are readily available over the counter, irrational and frequent dosing, especially in certain occupational groups, is a noted issue. Case presentation: A 28-year-old metal worker presented with a superficial cut on his forearm, managed with standard wound care, and reported a history of frequent tetanus vaccinations. Given his extensive vaccination history, a tetanus toxoid injection was deemed unnecessary, and he was educated on proper vaccination schedules and advised to seek medical attention for future injuries. Clinical discussion: Timely administration of vaccines for pre-exposure and postexposure prophylaxis is crucial for combating tetanus, with booster doses recommended every 10 years or as needed for wound management. High antibody titers from frequent tetanus vaccinations can increase the risk of adverse events, prompting guidelines to avoid administering Td more frequently than every 10 years unless necessary. Local reactions, like pain and swelling at the injection site, are common, while systemic reactions can include fever and peripheral neuropathy. Over-immunization is a concern in some regions, with frequent unnecessary booster doses potentially causing harm and highlighting the need for adherence to vaccination guidelines. Conclusion: Modifying and monitoring adult Td booster vaccination can lead to significant cost savings and fewer adverse events, requiring proper vaccination record-keeping, accurate assessment, and adherence to guidelines by healthcare workers.