India is set to replace the long-used tetanus toxoid (TT) vaccine with the Tetanus and adult Diphtheria (Td) vaccine, marking a significant update to its immunisation strategy. The new vaccine will be formally launched at the Central Research Institute (CRI) in Kasauli by Union Health Minister Jagat Prakash Nadda, signaling a decisive move toward broader disease protection.
This transition aligns India’s immunisation framework with long-standing global recommendations and strengthens safeguards against two serious bacterial infections—tetanus and diphtheria.
Why the Shift from TT to Td Matters
For decades, the TT vaccine has been administered to adolescents, adults, and pregnant women to prevent tetanus. While effective against tetanus, it does not provide protection against diphtheria.
The Td vaccine addresses this limitation by combining:
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Tetanus toxoid
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Reduced-dose diphtheria toxoid (adult formulation)
This dual protection ensures sustained immunity against both diseases, particularly in older age groups where diphtheria immunity may decline over time.
The transition reflects recommendations made by the World Health Organization, which in 2006 advised countries to phase out TT in favor of Td to maintain long-term diphtheria protection.
Understanding the Disease Burden
Tetanus
Tetanus is caused by Clostridium tetani, a bacterium commonly found in soil and dust. It enters the body through wounds and produces toxins that affect the nervous system.
Symptoms include:
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Severe muscle stiffness
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Painful spasms
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Difficulty swallowing
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Respiratory distress
Untreated tetanus can be fatal. India achieved maternal and neonatal tetanus elimination through sustained immunisation efforts, but continued booster protection remains critical.
Diphtheria
Diphtheria spreads through respiratory droplets and primarily affects the throat and upper airways. It can cause:
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Thick gray membrane in the throat
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Breathing difficulty
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Heart muscle inflammation
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Nerve damage and paralysis
Although childhood DPT vaccination has significantly reduced cases, immunity against diphtheria wanes over time, especially in adolescents and adults who do not receive booster doses.
The Td vaccine ensures booster protection, preventing potential resurgence.
Role of National Advisory Bodies
India’s National Technical Advisory Group on Immunization (NTAGI) recommended replacing TT with Td across all age groups, including pregnant women. The objective is twofold:
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Sustain maternal and neonatal tetanus elimination
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Strengthen diphtheria immunity in adolescents and adults
By adopting Td universally, India aligns with global immunisation best practices while addressing immunity gaps.
Manufacturing and Regulatory Preparedness
The new Td vaccine has been developed and manufactured by the Central Research Institute (CRI), operating under the Directorate General of Health Services.
Key milestones achieved by CRI include:
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Completion of developmental studies
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Securing regulatory approvals
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Clearance from the Central Drugs Laboratory
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Initiation of commercial-scale manufacturing
Following the official launch, CRI is expected to supply approximately 55 lakh doses to the Universal Immunization Programme (UIP) by April 2026. Production capacity is projected to scale further in subsequent years.
Strengthening the Universal Immunization Programme
India’s Universal Immunization Programme (UIP) is one of the largest public health initiatives globally, targeting millions of beneficiaries annually.
Replacing TT with Td enhances the programme by:
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Broadening disease coverage
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Reducing long-term diphtheria vulnerability
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Improving population-level immunity
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Aligning with global vaccine policy standards
This update ensures that booster doses administered during adolescence and pregnancy provide comprehensive protection rather than single-disease coverage.
Public Health Impact and Global Alignment
The shift is not merely procedural—it represents strategic modernization.
Benefits of Td Introduction:
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Maintains tetanus elimination status
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Reduces risk of adult diphtheria outbreaks
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Aligns India with WHO recommendations
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Enhances booster immunisation coverage
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Strengthens long-term herd immunity
Countries worldwide have already transitioned from TT to Td based on scientific reviews and global advisory consensus. India’s adoption underscores its commitment to evidence-based immunisation policy.
Addressing Waning Immunity
One critical public health consideration is waning immunity. While childhood vaccination through DPT (Diphtheria, Pertussis, Tetanus) significantly reduces disease incidence, antibody levels decline over time.
Adolescents and adults without booster doses may become susceptible again—particularly to diphtheria. The Td vaccine bridges this immunity gap efficiently.
This approach reflects preventive public health planning rather than reactive disease management.
Implementation and Next Steps
Senior ministry officials, state health representatives, and public health experts are expected to attend the launch event at Kasauli. Following rollout:
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States will integrate Td into routine immunisation schedules
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Healthcare workers will receive updated guidelines
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Public awareness campaigns may reinforce the importance of booster doses
Smooth transition logistics will be critical to ensure uninterrupted vaccine supply and compliance across states.
Conclusion
India’s decision to replace TT with the Td vaccine represents a forward-looking public health reform. By expanding protection to include diphtheria, the country strengthens its immunisation architecture while maintaining tetanus safeguards.
With manufacturing readiness, regulatory clearance, and advisory backing in place, the launch at Kasauli marks a pivotal milestone in India’s immunisation journey.
The transition underscores a fundamental principle of modern healthcare policy: preventive protection must evolve alongside scientific evidence and global standards.