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Vaccine watch: diphtheria and tetanus

Reading time: 12 minutes

The second part of our in-depth look at the DPT vaccine examines the diphtheria and tetanus portions of the triple jab. In this series we’re assuming that you’ve read the mainstream medical view of these vaccines, so, as usual, here’s the other side of the story.   

In making your decision about whether to vaccinate, we urge you to consider each vaccine individually. Each one has very different records of safety, effectiveness and indeed necessity. When making your informed decision, remember to consider three things:  

• How necessary is this vaccine?

• How effective is this vaccine?

• How safe is this vaccine?


Diphtheria is an acute respiratory infection caused by the Corynebacterium diphtheriae  bacteria. In its milder form, it may produce nothing more than a sore throat accompanied by fever and swollen lymph nodes. 

In severe manifestations, it can cause a thick membrane to form on the surface of the tonsils and throat, which may extend to the windpipe and lungs. Other complications include inflammation of the heart and paralysis of muscles in the throat and eyes. 

These complications can interfere with swallowing and breathing, leading to death in around 50 percent of cases. In the pre-immunization days, people acquired immunity to the disease through contracting the less severe form—cutaneous diphtheria, causing infected skin lesions and resulting in far fewer deaths.

How necessary is the diphtheria vaccine?

At one time, says the Centers for Disease Control and Prevention (CDC), diphtheria was the leading cause of death in children.

According to a 2021 report prepared by Public Health England,1 there were just two cases of diphtheria in England in 2020—one of them nontoxic, with the toxic one linked to a companion animal.

And according to the nonprofit National Vaccine Information Center (NVIC), the last confirmed case of diphtheria in the US occurred in 2003, and since 1980 there have been just zero to five cases per year. 

Compare this to 1942, which witnessed some 60,000 cases and 4,000 deaths, most traditionally linked to farm animals and dairy products (and also occurred during the midst of the Second World War). 

These days, diphtheria is extremely rare in developed countries with clean water, sanitation and adequate food. The rare outbreaks of diphtheria virtually always occur in impoverished areas with poor sanitation. 

An outbreak of diphtheria in Seattle, Washington, in the 1970s, largely among Native Americans, was attributed to low socioeconomic status, crowded living conditions and alcoholism.2 

Unless you are traveling to an area of great poverty or natural disaster where sanitation has been compromised, your or your
child’s risk of contracting this disease is exceedingly remote.

These days, small outbreaks mainly have occurred in countries like the Dominican Republic (14 cases) and Haiti (406 confirmed cases), and the incidence is mainly linked with all the usual crucibles of infectious disease: poverty, poor sanitation and crowded living conditions.

How effective is the vaccine?

To discover this, one has to examine earlier studies when these kinds of questions were still being asked—and answered—by scientists and government authorities. Although the CDC gives the vaccine credit for the near-eradication of the disease in the United States, and it is likely to have played some role, the diphtheria portion of the DPT vaccine hasn’t proved all that reliable. 

In 1975, an FDA-sponsored review entitled Bacterial Vaccines and Toxoids with Standards and Potency concluded, “For several reasons, diphtheria toxoid, fluid or absorbed, is not as effective an immunizing agent as might be anticipated.” 

A more recent test of the effectiveness of a diphtheria vaccine—albeit not the same one as used in the US or UK—occurred in the 1990s, when a massive epidemic occurred in the newly independent states of the former Soviet Union. More than 100,000 cases of diphtheria were reported by 1996.3 These cases were mostly caused by exposure to skin lesions; sharing beds, cups and water; and bathing infrequently, says the NVIC.  

One research study found that in a Russian population, 86.3 percent of diphtheria patients who had previously been given an adsorbed diphtheria-tetanus toxoid fell ill within a year after the first booster. The number of individuals unprotected on years three, four and five were 21 percent, 35.5 percent and 49.4 percent respectively.4

Health policy makers initially reacted to news that vaccination hadn’t wiped out the disease by promoting earlier and earlier immunization of children. But earlier diphtheria immunization does not appear to confer any benefit in terms of long-term antibody levels.5 

In fact, one study revealed that infants given a DTP jab at birth actually had a lower antibody response to diphtheria and other illnesses such as Hib meningitis (now included in the six-in-one jab given to babies in the UK) compared to those given the shots in the usual schedule.6

“Newborn DT administration does not enhance subsequent antibody responses to Hib conjugate vaccines, and may lead to suppression of Hib and diphtheria antibody responses,” wrote the researchers from University of California, Los Angeles.  

Nor does giving a pregnant woman a DTP booster confer any benefit to her child. In one small study, the children of mothers given a booster during pregnancy had, initially, a lower immune response to diphtheria, even after their first two injections of DTP, although after the third booster their immune response jumped to normal.7

US policy tacitly acknowledges the waning effect of the vaccine by recommending that adults have booster shots every 10 years.  

Booster shots for mom

The FDA has not licensed the DTP for use in pregnancy, and it is the Tdap vaccine booster vaccine used in pregnancy for the protection of newborns, although no trials on the safety of giving Tdap boosters during pregnancy were conducted prior to its licensure.

An unexpected finding is that prenatal (maternal) vaccination with Tdap interferes with the immune response to the infant’s primary DTaP series, according to the World Health Collective, which cites research showing lower antibody titers to pertussis antigens at 6, 7 and 12 months of age. “This study demonstrated that Tdap during pregnancy results in higher levels of antibodies early in infancy but lower levels after the primary vaccine series,” the Canadian researchers concluded.1 

A subsequent 2021 study of the effect of maternal Tdap vaccination on the unborn baby’s innate immune system—the first of its kind—determined that vaccinated and unvaccinated infant immune systems respond very differently to pertussis. 

Babies born to Tdap- vaccinated mothers have an altered distribution of white blood cells (monocytes) at birth, and infants from vaccinated pregnancies showed differences in some immune system signaling (cytokine) responses to B. pertussis at birth, seven weeks of age and five months of age.2 

How safe is the diphtheria vaccine?

According to the NVIC, in the US alone, using their own MedAlerts search engine, a powerful VAERS database search engine, as of March 31, 2020, “there have been more than 187,344 reports of adverse reactions, hospitalizations, injuries and deaths following diphtheria vaccinations made to the federal Vaccine Adverse Events Reporting System (VAERS), including 3,207 related deaths, 22,619 hospitalizations, and 3,292 related disabilities.”

More than 60 percent of those vaccine-related side-effects occur in children under six. 

Although diphtheria is always administered as a combination vaccine in the US and the UK (and now the six-in-one vaccine with pertussis, tetanus, inactivated polio, Hib meningitis and hepatitis B vaccines), adverse reactions recorded in VAERS include a temperature above 105°F or higher, plus many of the effects seen with the pertussis vaccine: hypotonic-hyporesponsive episodes (collapse or shock-like state), persistent crying lasting three hours or more, convulsions alone or accompanied with fever and encephalopathy causing a coma, decreased prolonged convulsions and/or a decreased level of consciousness. 

As of May 1, 2020, says the NVIC, some 5,879 claims have been filed in the federal Vaccine Injury Compensation Program (VICP) for injuries and deaths following diphtheria vaccination. These include 867 deaths and 5,012 serious injuries.8 


Tetanus is caused by Colstridium tetani, a spore-forming bacteria, which can become trapped in wounds that aren’t cleaned properly. When the body is in the grip of tetanus infection, the body’s muscles tighten, the jaw muscles go into spasms, making it difficult to open the mouth, and the patient suffers headaches, depression and convulsions. 

The great fear about tetanus has always centered around puncture wounds (the proverbial rusty nail) or getting hurt on a farm in the presence of manure, which is supposedly riddled with tetanus spores. 

Although it is true that tetanus spores can grow in deep puncture wounds (because they do best in this type of an oxygen-free environment), cleaning the wound properly and not allowing it to close until healing has occurred below the skin surface will mostly eliminate the possibility of tetanus. 

There are 12 different tetanus-containing vaccines licensed for use in the US, which includes combination vaccines available for use in infants and children. Adults are offered one or more of four possible tetanus combo vaccines, with two versions of the DT approved for adults and children over seven years old. 

How necessary is the tetanus shot?

Long before the vaccine was introduced, deaths from tetanus were rapidly declining largely because of increased wound hygiene.1 

In the mid-1800s, during the US Civil War, for instance, tetanus occurred in 205 cases for every 100,000 wounds. Just 100 years later, during World War II, the incidence of tetanus had declined by 99 percent. What that actually translates to is that among all the soldiers of World War II, only 12 cases of tetanus were recorded—a third of which occurred among soldiers who were vaccinated.2 

By the mid-twentieth century, the disease was rare, but it’s now getting even rarer. In the US, between 1985 through 1992 there were 467 cases of tetanus—an average of 55 per year.3 In 1994, there were three reported cases and no deaths; the year before there had been three deaths out of six total cases, all in women over 75. 

More than half of all untreated patients with tetanus die; however, we now know how to treat tetanus. When treated correctly some 80 percent of patients recover. 

The rise of SIDS

SIDS, or “crib death,” as it was once called, was such a rare phenomenon in the 1960s that it was not even included in the list of possible causes of infant death. Then, toward the end of that decade, a vaccination program was introduced, and for the first time, American infants were required to have the DPT (diphtheria-tetanus-pertussis [whooping cough]), polio and MMR (measles-mumps-rubella) jabs.   

By 1969, a new cause of infant death—dubbed “sudden infant death syndrome,” or SIDS—had entered the medical lexicon, and it was sufficiently prevalent by 1973 to be included in the US National Center for Health Statistics. By 1980, it had become the leading cause of death among infants between 28 days and one year old in the US.1

The average annual SIDS rate fell by 8.6 percent between 1992 and 2001 following the success of the “Back to Sleep” campaign, advising parents that babies should be placed on their backs for sleeping. 

However, critics argued that this supposed decrease was achieved by merely massaging the numbers. Other causes of death among newborns—such as “suffocation in bed,” “suffocation-other” and “unknown and unspecified causes”—increased dramatically. 

Rates of “suffocation in bed” alone rose by more than 11 percent, and the overall increase in the other categories more than wiped out any reduction in SIDS.

SIDS is defined as the “sudden and unexpected death of an infant which remains unexplained after a thorough investigation,” and although specific symptoms are not detected, autopsies have often discovered congestion and edema of the lungs and inflammation in the respiratory tract.2

One study revealed that two-thirds of SIDS victims had been given the DPT vaccination. Of these, 6.5 percent died within 12 hours of vaccination, 13 percent within 24 hours and 26 percent within three days. The researcher concluded that the vaccine “may be a generally unrecognized major cause of sudden infant and early childhood death, and that the risks of immunization may outweigh its potential benefits.”  

However, this study also claimed that the risk of death was lower for vaccinated children vs. unvaccinated, although it did say that the higher rate of SIDS among the unvaccinated may be down to other factors, such as socioeconomic ones.3 

Researchers at Boston University reported that the rate of SIDS was 7.3 times higher in the first three days following DPT vaccination compared with the 30-day-plus period, although the authors claimed the risk of SIDS was overall higher for non-vaccinated children and concluded that the risks caused by the DPT shot may be associated with birth weights over 2,500 gms.4

How effective is the vaccine?

Again, we have to examine earlier studies when such questions were asked—and answered truthfully.

In a community survey, conducted in Australia, of 430 randomly selected adults over 49, only half had levels of tetanus antibodies high enough to be considered protective. Furthermore, although 35 percent of patients reported that they’d been vaccinated in the last 10 years, self-reported vaccination history didn’t always correlate with a person’s level of immunity.4

Nevertheless, the incidence of tetanus is as rare there as it is in England,5 even though studies in England also find that elderly patients have lower levels of antibody protection.6

Once infants have their tetanus shots, medicine recommends a booster every 10 years. However, there’s evidence that the more shots you get, the lower your immunity. Additional boosters can actually reduce the sensitivity of an individual’s response to tetanus toxoid antigen, according to a Lancet editorial.5

Although studies of immediate response to tetanus vaccination show very high protective antibody levels, this effect quickly wears off. In one study of 84 pregnant African patients, only 29 percent had detectable antibodies in the blood, even though 74 percent had been immunized within the three years preceding the study.7

Nevertheless, other studies show high detectable antibody levels of between 76–89 percent after 10 years.8 But as in many cases of vaccination, although antibody levels may be high, this may mean nothing in terms of protecting against disease. 

In one report from Finland, among the five children between 5 and 15 who contracted tetanus between 1969 and 1985, four of them had had their full quota
of shots.

In 1994, an Institute of Medicine-sponsored panel reviewing vaccines agreed that the vaccine has a spotty record of effectiveness. The panel noted that the degree of potency of the vaccine can vary considerably from preparation to preparation. The panel also concluded that, as the vaccine has been purified and made safer in order to prevent reactions to it, so its protective ability has diminished.

How safe is the tetanus shot?

Even the weaker form of this vaccine has an impressive list of serious side-effects. The 1994 Institute of Medicine study of vaccine damage concluded that the tetanus vaccine could cause high fever, seizures, pain, nerve damage, fatal anaphylactic shock (a severe, life-threatening allergic reaction), degeneration of the nervous system and Guillain-Barre syndrome, a neurological condition that can cause paralysis.10

The New England Journal of Medicine  also reported that tetanus boosters can cause T-lymphocyte blood count ratios to temporarily plunge to below normal levels—similar to those of AIDS victims.11

More recently, the NVIC quotes the CDC reporting that in the event of the most common tetanus vaccine reactions—redness, pain and swelling at the site of the injection—this pain and swelling can become significant, extending from the shoulder to the elbow, in which case the agency advises that this toxoid should not be given more frequently than every 10 years. 

The 1994 report mentioned above from the Institute of Medicine concluded that there was sufficient evidence that the tetanus toxoid shot, alone or in combination with diphtheria, can cause Guillain-Barre syndrome (GBS) including death, brachial neuritis (pain or loss of function in the nerves that carry signals to the chest, shoulder, arm and hand), and death from anaphylaxis (serious allergic shock).12

However, by 2012, the IOM had changed its mind, claiming a lack of evidence to either confirm or deny a causal association between this vaccine and GBS, encephalopathy, seizures, autism, transverse myelitis (inflammation of the spinal cord causing motor and sensory dysfunction), multiple sclerosis and much more. The IOM did concur, however, that the vaccine could cause anaphylactic shock. 

Nevertheless, a raft of published scientific studies, cited by the NVIC, show evidence that the vaccine can cause a wide range of damages to the nervous and other systems, including brachial neuritis; bullous pemphigoid (a rare skin condition causing large, fluid-filled blisters in  the lower abdomen, upper thighs or armpits); GBS; acute disseminated encephalomyelitis (widespread inflammation of the brain and spinal cord that damages nerve fibers); erythema multiforme (a skin rash usually triggered by an infection); arthritis, myocarditis (inflammation of the heart muscle), optic neuritis and other autoimmune disorders.13

It’s also been linked with encephalomyelitis (inflammation of the brain).14 The DT jab on its own has been linked with encephalopathy in children—loss of consciousness, convulsions, headache and neurological problems.15

In an English study of 18,000 children given three doses of DT, 18 children had febrile seizures, and three suffered another neurologic disease, two with seizures. One of the three died of encephalopathy.16

As of May 31, 2019, there have been over 184,528 adverse events reported to the US Vaccine Adverse Events Reporting System (VAERS) in connection with tetanus and tetanus-containing vaccines combined with additional vaccines since 1990, including 3,172 related deaths, 22,002 hospitalizations, and 3,265
related disabilities. 

However, once again the numbers of vaccine-related injuries and deaths reported to VAERS are estimated to reflect only about 1 to 10 percent of the true number of serious health problems that develop after vaccination.

The bottom line is that we don’t know the true figures.

Booster shots in older children have demonstrated a high level of side-effects as well.17 Even when the diphtheria and tetanus jabs are administered without the whooping cough component, side-effects are common. 

Side-effects are common

In one study of 139 Spanish medical students and health workers, most subjects reported some kind of side-effect, with more than one in 10 reporting a systemic problem like malaise or headache.

What is the vaccine made of? 

DTaP/Tdap vaccines contain antigens against each of the three disease pathogens, diphtheria, tetanus and pertussis. The pertussis is killed in hydrogen peroxide, and the Td (Tenivac, TDVAX) vaccines contain diphtheria and tetanus toxoids, inactivated with formaldehyde. 

The DTap/Tdap vaccines also contain the neurotoxic metal aluminum in the form aluminum phosphate or aluminum hydroxide, as well as formaldehyde, glutaraldehyde, 2-phenoxyethanol, sodium chloride, polysorbate 80 and trace milk protein casein—a potential problem for those with dairy allergies. 

GSK’s Infanrix shot containing DTP claims to contain 0.82 mg of aluminum on the label, but the actual weight of hydrated aluminum salt (e.g. aluminum oxyhydroxide, aluminum hydroxyphosphate and aluminum hydro-xyphosphatesulphate) in any vaccine preparation is actually approximately ten-fold higher, according to aluminum researcher Christopher Exley. 

“Thus, the weight of aluminum salt in this vaccine is approximately 8 mg, which is approximately ten times the weight of all of the other components of the vaccine when combined,” he says. “An aluminum-adjuvanted vaccine is essentially a very high concentration of an aluminum salt (8 mg/0.5 mL or16 mg/mL or 16 g/L).”

Exley also explains how this is very different from the aluminum a baby might ingest. “On day 56 the infant receives a single dose of 0.82 mg of aluminum in the Infanrix Hexa vaccine, a dose equivalent to three times the amount of aluminum the infant received during the entire 55 days of life prior to its vaccination. 

“In fact, just a single dose of Infanrix Hexa vaccine represents a severe acute exposure to systemically available aluminum,” explains Exley. And this is only the first dose of three Infanrix injections in infancy and does not include aluminum from
other vaccines.

“Long-term persistence of vaccine-derived aluminum hydroxide is associated with chronic cognitive dysfunction,” concluded a study by researchers from the University of Paris.1 

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Diphtheria  References


Public Health England, April 13, 2021. “Diphtheria in England: 2020” Health Protection Report Vol. 15 No. 7 


Public Health Rep, 1977; 92(4): 336–42


MMWR Morb Mortal Wkly Rep, 1995; 44(10): 177–81


Zhurnel Mikrobiologii, Epidemiologii i Immunobilogii, 1994; 3: 57–61


Lancet, 1993; 342: 203-5


J Pediatr, 1995; 126(2): 198–205


Ped Infect Dis J, 1995; 14: 846–50


US Health Resources & Services Administration, National Vaccine Injury Compensation Program, May 1, 2020, “Monthly Statistics Report”


Booster shots for mom



Clin Infect Dis, 2018; 67(7): 1063–71


EBioMedicine, 2021; 72: 103612


Tetanus References


Richard Moskowitz, Vaccines: A Reappraisal (Skyhorse, 2017)


Science, 1978; 200(4344): 902–7, as quoted in Neil Z. Miller, Vaccines: Are they Really Safe and Effective? (New Atlantean Press, 1992: 32)


MMWR, 1993; 42: 768–70


Med J Australia, 1996; 164: 593–6


Lancet, 1996; 348: 1185–6


J Infect, 1993; 27(3): 255–60


Afr J Med Med Sci, 1994; 23 19–22


Atencion Primaria, 1994; 14: 707–10


Dev Med Child Neurol, 1993; 35: 351–5


Institute of Medicine Committee to Review Adverse Effects of Vaccines. Adverse Effects of Vaccines: Evidence and Causality (National Academies Press, 1994: 261)


N Engl J Med, 1984; 310(3): 198–9


Institute of Medicine Committee to Review Adverse Effects of Vaccines. Adverse Effects of Vaccines: Evidence and Causality (National Academies Press, 1994: 67–117)



J Radiologie, 1996; 77: 363–6


Boll Ist Sieroter Milan, 1984; 63(2): 118–24


Lancet, 1983; 1(8327): 753–7


Vaccine, 1994; 12: 427–30


Med Clin (Barc), 1995; 104(4): 126–9


The rise of SIDS



Pediatrics, 2002; 109: 274–83


Pediatr Pathol, 1991; 11: 677–84


Torch, WC. Presentation at the 34th Annual Meeting of the American Academy of Neurology, April 25-May 1, 1982, Washington, DC


Am J Public Health, 1987; 77: 945–51


What is the vaccine made of? 



J Inorg Biochem, 2009; 103(11): 1571–8

Article Topics: Tetanus, vaccination, vaccine
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