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The tetanus vaccine provides protection that decreases over time; for most people, the protection from a booster lasts about 10 years, and adults should get a booster every 10 years to maintain it. Protection after the initial childhood series lasts for at least 10 years, with boosters needed every decade after that to ensure continued immunity against the tetanus bacteria. so they probaly don't have it because why would you have it unless you have been in a soecific situation (f.e. stepled onto a rusty nail)
but what did he eat during that time ?
reasonable crashout
if they will live for eternity they could just slowly take over the empire noble by noble , the only problem at the start would be the lack of new children being born
they could try to only controll the more remote places first and after a while go to more and more populated places
finally someone thought of this I'v been thinking about since it was revealed that he can turn others into vampires