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Frequency of medically attended adverse events following tetanus and diphtheria toxoid vaccine in adolescents and young adults: a Vaccine Safety Datalink study

Lisa A Jackson1*, Onchee Yu1, Edward A Belongia2, Simon J Hambidge3, Jennifer Nelson14, Roger Baxter5, Allison Naleway6, Charlene Gay7, James Nordin8, James Baggs9 and John Iskander9

Author affiliations

1 Group Health Research Institute, Seattle WA, USA

2 Epidemiology Research Center, Marshfield Clinic Research Foundation, Marshfield WI, USA

3 Kaiser Permanente Institute for Health Research and Denver Health Community Health Services, Denver CO, USA

4 Department of Biostatistics, University of Washington, Seattle WA, USA

5 Kaiser Permanente Vaccine Study Center, Oakland CA, USA

6 Kaiser Permanente Northwest, Portland OR, USA

7 Department of Ambulatory Care and Prevention, Harvard Pilgrim Health Care and Harvard Medical School, Boston MA, USA

8 HealthPartners, Minneapolis MN, USA

9 Centers for Disease Control and Prevention, Atlanta GA USA

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Citation and License

BMC Infectious Diseases 2009, 9:165  doi:10.1186/1471-2334-9-165

Published: 5 October 2009



Local reactions are the most commonly reported adverse events following tetanus and diphtheria toxoid (Td) vaccine and the risk of local reactions may increase with number of prior Td vaccinations.


To estimate the risk of medically attended local reactions following Td vaccination in adolescents and young adults we conducted a six-year retrospective cohort study assessing 436,828 Td vaccinations given to persons 9 through 25 years of age in the Vaccine Safety Datalink population from 1999 through 2004.


Overall, the estimated risk of a medically attended local reaction was 3.6 events per 10,000 Td vaccinations. The lowest risk (2.8 events per 10,000 vaccinations) was found in the 11 to 15 year old age group. In comparison with that group, the event risks were significantly higher in both the 9 to 10 and 21 to 25 year old age groups. The risk of a local reaction was significantly higher in persons who had received another tetanus and diphtheria toxoid containing vaccine (TDCV) in the previous five years (incidence rate ratio, 2.9; 95% confidence interval, 1.2 to 7.2). Twenty-eight percent of persons with a local reaction to Td vaccine were prescribed antibiotics.


Medically attended local reactions were uncommon following Td vaccination. The risk of those reactions varied by age and by prior receipt of TDCVs. These findings provide a point of reference for future evaluations of the safety profile of newer vaccines containing tetanus or diphtheria toxoid.