Tetanus vaccines are based on tetanus toxoid, a modified neurotoxin that induces protective antitoxin. Tetanus toxoid vaccines are available as single toxoid (TT), combined with diphtheria toxoid (DT) or low-dose diphtheria toxoid (dT) and in combination with diphtheria and pertussis vaccines (DTwP, DTaP, dTaP or dTaP). In addition several new combinations containing DTP/DTaP have been marketed, including vaccines against hepatitis B, Haemophilus influenza type b and poliomyelitis (polio).

Three DTP doses in infancy will give 3–5 years’ protection, a further dose or booster (e.g. in early childhood) will provide protection into adolescence, and 1 or 2 more booster(s) will induce immunity well through adulthood; a duration of 20–30 years has been suggested.

In the WHO Eastern Mediterranean Region, the target for each country is to reach at least 90% DPT3 coverage at national level and at least 80% in every district. From 2000 to 2010, the regional average of DPT3 coverage increased from 73% to 87%. Despite this remarkable progress in many countries of the Region, DPT 3 coverage remains very low in Somalia (45% in 2010) and South Sudan (43%). Yemen has the lowest TT2+ coverage rate of 17%.