Query: Recently I took a tetanus injection after I fell down and sustained cuts and bruises around my knee. I took another tetanus injection just 2 months back when I had injured my thumb with a paper-cutting knife. Are frequent tetanus injections harmful?
Response: It is unfortunate that it has become almost a reflex action for many of us to get a shot of ‘TETVAC’ i.e. tetanus toxoid after every cut injury. The fact is that if one is properly immunized against tetanus, then it is not necessary to take tetanus shots after every cut. Primary immunization against tetanus, with the standard adsorbed preparations of tetanus toxoid (TT) that are available in India, consists of 3 intramuscular doses of 0.5 ml each - the 2nd dose is taken 1 month after the 1st, and the next 6 months after the 2nd. In the national immunization schedule, 3 shots are given as a component of DPT injections with TT boosters at school entry and exit. To prevent neonatal tetanus, pregnant women who are not properly immunized against tetanus receive 2 shots of TT at 1 month interval in case of the first pregnancy, and a single booster dose in case of a subsequent pregnancy after 1 year. Tetanus spores mostly occur in soil and dirt. If a person’s primary immunization status is unknown or if immunization is incomplete, then tetanus injection may be recommended for ‘unclean’ cuts i.e. those contaminated with soil or dirt or inflicted by dirty objects. However, in this case it is important to stress on completion of primary immunization. A single shot actually does not give adequate protection to a non-immune individual as the immune system is not sufficiently stimulated. It is only with the 2nd and 3rd shots that protective immunity develops. Subsequent reinforcing doses are sufficient if taken at 5 - 10 year intervals. More frequent boosters are unnecessary even if the wound is mildly contaminated. If a wound is heavily contaminated and particularly tetanus-prone, then passive immunization with tetanus immunoglobulin is necessary, in addition to wound toilet, TT booster and antibiotics, for adequate protection. It is not known whether frequent tetanus injections are harmful, although any injection carries the risk of introducing additional infection and hypersensitivity (allergic) reactions may develop. The injection is inexpensive, which is one reason why it is used even after minor cuts and bruises. Obviously, use in this manner is irrational and should be discouraged.

Query: Our son was suffering from vivax malaria and our family physician prescribed medicines for fever (paracetamol), vomiting (metoclopramide) and malaria (chloroquine) for him. On the second day after starting the medicines, he complained of funny sensations around his mouth and we noticed that the angle of his mouth was deviating to the left. On contacting our doctor, he stopped the medicines for fever and vomiting as both had subsided by then and reassured us that there was nothing amiss. Our son recovered fully but we are curious to know what had happened?
Response: You have experienced a well-known side-effect of metoclopramide, the drug which was given for vomiting. In doctors’ parlance the reaction is a type of extrapyramidal reaction called acute dystonia. Disturbances of muscle tone lead to spasm and involuntary movements, frequently affecting the muscles in the head and neck region. The reaction subsides once the drug is stopped and its effect wears off. However, before that, it can become severe enough to alarm the patient and even require short-term hospitalization. Since metoclopramide has the propensity to cause such reactions more frequently in children and adolescents than in adults, extra care is required in its use in these age groups although the drug is not forbidden. The British National Formulary, a highly respected drug compendium for doctors, recommends restricted use of metoclopramide in children and young adults. If the drug is to be used at all, its dose should not exceed 500 micrograms per kilogram body weight and oral syringes / pipettes should be used for accurate dosing in young children. Further, this drug occurs in several branded medicines for ‘dyspepsia’, ‘acidity’ and ‘gas’. Hence such medicines should not be used casually in children. It is best to seek your physician’s advice beforehand.
Responses submitted by Dr. Avijit Hazra, MBBS, MD.

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