Tetanus toxoid vaccination has been part of the routine immunisation schedule in New Zealand (NZ) since 1958 and was funded from 1960. Prior to that time, tetanus toxoid (TT) had been used for voluntary vaccinations since the 1940s and 1950s, and was often delivered to those on military service. The number of doses provided by the National Immunisation Schedule (the Schedule) has increased over the decades from four childhood doses commencing in 1960.

To help inform the New Zealand Immunisation Schedule, this review of evidence was conducted to investigate key questions:

1. Under the current Schedule in NZ, is tetanus protection adequate for the whole life?

2. How necessary are the currently funded tetanus vaccine booster doses at 45 years and 65 years of age?

3. Which groups are at highest risk of tetanus and can we improve the immunisation programme to provide greater protection for those most at risk?

4. For tetanus prophylaxis in wound management, is a booster dose needed for a tetanus-prone injury when it is more than 5 years since the last tetanus vaccine dose for those who have been fully immunised?

5. Does using tetanus toxoid as the carrier protein in conjugate vaccines, e.g. ten-valent pneumococcal and Haemophilus influenzae type B (Hib) conjugate vaccines, contribute to tetanus immunity?

6. Is there a need for further tetanus vaccine boosters in the context of other antigens, e.g. pertussis immunisation?

This review of evidence is not a systematic review and cost-benefit analyses are not considered. Evidence-based scientific literature, systematic reviews and review articles published during 2015-2018 are reviewed.