Current UK policy on immunisation for tetanus has changed in the light of evidence that five doses of vaccine probably provides sufficient protection as long as high-risk wounds are managed with tetanus immunoglobulin. This paper reviews the evidence base for tetanus immunisation policy in England and Wales: the epidemiology of tetanus, vaccination coverage and response to tetanus toxoid, and population immunity to tetanus. The paper highlights gaps in our current knowledge of tetanus vaccination and policy implementation, and makes recommendations for further investigations.