Mandatory tetanus vaccine

In a working environment

The law of 5 March 1963, n. 292¹ (and subsequent amendments), made tetanus vaccination mandatory for these job categories:

1. agricultural workers,
2. shepherds,
3. cattle ranchers,
4. grooms,
5. jockeys,
6. tanners,
7. supervisors and workers in charge of organizing and preparing tracks in racecourses,
8. scavengers,
9. roadmen,
10. streets,
11. excavators,
12. miners,
13. kilnsmen,
14. construction workers and laborers,
15. to all railway personnel listed under the heading "operating personnel",*
16. asphalters,
17. rag pickers,
18. garbage handlers,
19. workers involved in the manufacture of paper and cardboard,
20. wood workers,
21. metallurgists and metalworkers,
22. to all seafarers and dock workers.**

*With Ministerial Decree of 22 March 1975 (in Official Gazette 29/03/1975, n. 85)² the obligation of tetanus vaccination has been extended to all railway personnel listed under the heading "operating personnel".
**With Ministerial Decree 16 September 1975 (in Official Gazette 22/10/1975, n. 304)³ "the obligation to have anti-tetanus vaccinations was extended... to all seafarers and port workers starting from the new generation of workers".

Biological risk in the workplace is governed by Legislative Decree 81/2008⁴ and provides for the verification of work eligibility through the Competent Doctor, appointed by the employer. Remember that under no circumstances can the employer be made aware of your vaccination status.

We also remind you that the National Vaccination Prevention Plan⁵ provides for the booster of the tetanus vaccination (available in single formulation) every 10 years.

NB It is always possible and even advisable to check one's own antibody coverage, which especially in subjects already vaccinated in the past, is often more than sufficient even after 10 years. Find more information about this at the end of this article.

NBB For the same principle as in the working environment, the anti-tetanus vaccination is often required for the laboratories of agricultural, engineering and similar institutes. Although being a school sector, laboratories are treated by many institutes as working environments and apply the same legislation.

Competitive sports activity with affiliation to the CONI federation

As regards the compulsory practice of competitive sports, the same law made tetanus antibody compulsory as a requirement upon affiliation to the CONI federations (Italian National Olympic Committee) and at the time of the sports suitability visit, the presentation of the vaccination booklet proving the tetanus vaccination is required. 

NB It is always possible and even advisable to check one's own antibody coverage, which especially in subjects already vaccinated in the past, is often more than sufficient even after 10 years. Find more information about this at the end of this article.

Competitive sports activity not affiliated to the CONI federation

Medical certification in the sports field has undergone significant changes in recent years, above all as a result of the issue of Law Decree no. 158 of 13 September 2012 (so-called Balduzzi Decree)⁶, converted, with amendments, by Law 8 November 2012 n. 189, as well as the subsequent Ministerial Decree of 24 April 2013.⁷

In general, tetanus vaccination is not mandatory.

NB for all sports independent of CONI federations or bodies, it is not necessary to present any vaccination documentation. However, the documentation could be requested by the sports medical center that issues the certificate. In this case, we can ask for reference legislation or try another center, even a private one. 

NBB Although vaccination is not mandatory for CONI federations or non-federated bodies, we know that the tetanus vaccination is required for equestrian sports and by sports associations belonging to the Italian Rugby Federation.

Sports activity in pre-school age (children 0-6 years)

On 28 February 2018, the Ministry of Health, in agreement with the Ministry of Sport, issued an interministerial decree⁸ which sanctioned the abolition of the obligation of medical certification for the exercise of sports in pre-school age, precisely for children up to 6 years of age. In this age range, therefore, sporting activity is considered a recreational-motor activity and it follows that no vaccination certification is required.

Non-competitive sporting activity

The Ministerial Decree of 24 April 2013 (GU n.169 of 20-7-2013),⁹ defines amateur and non-competitive sports activities, establishing the legislation to be applied in relation to medical certifications and for non-competitive sports activities the non-competitive sports medical certificate is required, which is subject to different medical tests based on the sport category. In any case, the vaccination certificate is not one of the required checks.

NBB Although vaccination is not mandatory for CONI federations or non-federated bodies, we know that the tetanus vaccination is required for equestrian sports and by sports associations belonging to the Italian Rugby Federation. In these cases you can try to find a compromise by proposing an indemnity, a discharge of liability to the center concerned. If such an opening is not found, we will explain the possible options in the following paragraph.

What to do if vaccination certification is requested?

On the subject of vaccination there is a pre and a post Lorenzin. If until 2016 it was possible to find sports centers with personnel open to the topic and one of the possibilities was to present an indemnity, a clause of exemption from liability towards the sports association, today we can tell you that this possibility has greatly reduced and there are not many known cases where such a compromise was accepted.

The main possibility, both in the workplace and in sports, is to perform an antibody titration, i.e. a search for specific antibodies against tetanus toxin to evaluate the state of immunity. Yes, it is a simple venous blood sample that can be done privately in any analysis center (indicative cost €10/20).

It should be remembered that it frequently happens that positive results are obtained, which indicate coverage, and the presentation of these results to the competent doctor, sports doctor or occupational doctor, allows vaccination to be deferred.

NB this deferral lasts over time in relation to the quantity of specific anti-tetanus toxin antibodies, the hypothetical duration of coverage and therefore the need to repeat the exam after a certain amount of time is usually directly indicated in the results of the laboratory tests .

Why antibody titration and what are the risks of vaccination?

As the Corvelva Association we are not afraid to criticize any type of vaccination policy, especially the wicked ones in which the discrepancies between the adopted rules and what "science" has always considered correct are clear. 

 The Ulss22 of the Veneto, at least until 2003, candidly admitted, in black and white in the titled document "Tetanus immunoprophylaxis - analysis of the legislation and indications from the scientific literature",⁹ That "...the international literature is in fact highlighting that the subjects who have performed the decennial boosters would not seem to be better protected than those who have correctly performed only the primary cycle of 3 doses. (...) The consulted literature highlights the very long persistence of the protection ensured by the basic primary cycle... However, this protection is not always correlated with the antibody titre: indeed, even with antibody titres lower than 0,01 IU/ml (the so-called protective level) there is evidence of efficacy in vaccinated subjects"

Not only that, with regard to re-vaccination in the presence of high antibody titration, "... there are also some very rare reports of cases (...) occurring in hyper-immunized people ... Therefore, in the face of a good protection guaranteed by vaccinations, regardless of whether or not the boosters have been taken, the disadvantages of the same are well known, represented by the appearance, albeit rarely, of adverse reactions such as brachial neuritis, Guillan Barrè syndromes and serious allergic. It should also be noted that the frequency of adverse events to vaccination is also related to the number of doses already administered."

 In conclusion, the verification of the antibody titration helps to avoid the problem of hyper immunization and an occupational or sports doctor, when asking you about your vaccination status, should in our opinion advise you to perform these analyzes since the famous The scientific community has always realized that theThe frequency of these adverse reactions is not justifiable in the face of the little or perhaps no benefits that the execution of decennial recalls, let alone closer ones. 

NBB the provisions relating to the mandatory tetanus and diphtheria vaccination for newborns starting from the third month of life, also included in the law of 5 March 1963, n. 292, have substantially merged into Law 119/17 which made 10 vaccinations mandatory in the 0-16 age group, including tetanus and diphtheria.
Therefore, for this age group, reference should also be made to law 119/2017, which does not regulate sports activities but still establishes the schedule of administration, in accordance with the PNPV National Vaccination Prevention Plan.

Is the free choice to get vaccinated really free?

Net of the fact that it is an oxymoron to think of freedom in a mandatory regime, in the hypothesis that you have "chosen" to get vaccinated, for whatever reason, know that perhaps you will have to embark on a small obstacle course.

The two reference vaccines, Anatetall and Imovax Tetanus, are often in short supply and are therefore not available to the local health authorities, so the same, as a matter of practice, tend to inoculate the DTPa vaccine (diphtheria-tetanus-acellular pertussis).
Most people who do not inform themselves, when they take a booster for tetanus, obviously without having checked their immunization status, will find themselves getting a vaccine that also contains the antigens of two other diseases.
In our experience, if you have decided to get vaccinated for tetanus you will first need to call your ASL and ask specifically if the booster you will need to do is offered in a single-component formula only for tetanus or in a DTP formulation, precisely diphtheria-tetanus-pertussis.

does not have the single component in that period, you have the possibility of having a prescription made by your doctor and proceeding in this way, perhaps by calling a couple of pharmacies, physically obtaining it for you. Pay particular attention to timing, we are aware of the fact that in some periods monovalent anti-tetanus vaccines are practically unobtainable and timing must be considered (think of a worker required by law, free of antibodies and who has a pre-set work medical examination in a certain month).

Once you have the vaccine, you can go back to your General Practitioner to have it inoculated. The doctor himself will provide you with a document drawn up by him including the day of vaccination, the commercial name of the vaccine and the batch number. This document must be presented by you to your ASL in order to "register it" so that it goes on your vaccination booklet.
As you can see, even "choosing" to get vaccinated in Italy is complex and complicated if you don't accept everything the industry produces.

Sources

1. Law 5 March 1963, n. 292
2. Ministerial Decree of 22 March 1975
3. Ministerial Decree of 16 September 1975
4. D.Lgs 81 / 2008
5. National Vaccine Prevention Plan
6. Law Decree n. 158 of 13 September 2012
7. Ministerial Decree of 24 April 2013
8. https://www.trovanorme.salute.gov.it/norme/renderNormsanPdf?anno=2018&codLeg=63494&parte=1%20&serie=null
9. CORVELVA: Tetanus immunoprophylaxis - analysis of the legislation and indications from the scientific literature

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