Summary Guide to Tetanus Prophylaxis in Routine Wound Management

A summary guide to examining wounds for possible tetanus prophylaxis.

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1. Primary series: A minimum of three doses of tetanus toxoid-containing vaccine (Tdap, DTaP or Td). Persons with unknown or uncertain tetanus vaccination history should be considered not vaccinated.
2. Age-appropriate vaccine: Infants or children under 7 years of age: DTaP (or Td if pertussis component is contraindicated).
   • Persons 7 years of age and older: Td is acceptable for routine 10-year boosters or catch-up vaccination.
     • Tdap is preferred as the first dose for those 11 years of age and older who have not previously received Tdap.
     • If Tdap has been given previously and another tetanus toxoid-containing dose is indicated (nonpregnant), either Td or Tdap may be used.
   • Pregnancy: If a tetanus toxoid-containing dose is indicated, Tdap should be used.
3. Tetanus immune globulin (TIG):
   • Dose: 250 U IM for all ages when indicated.
   • Administration: If both TIG and vaccine are required, give simultaneously in separate syringes and at different anatomical sites.
   • Indications (give TIG in the following situations):
     • Persons with less than three documented doses of tetanus toxoid–containing vaccine, or with unknown vaccination history, who present with contaminated wounds.
     • Infants less than 6 weeks of age with contaminated wounds (no vaccine is licensed at this age; give TIG only).
     • Infants over 6 weeks of age who have received only one prior DTaP dose less than 4 weeks earlier and present with a contaminated wound. Give TIG now for immediate protection and defer the second DTaP dose until 4 weeks or more after the first dose so it is valid and can contribute to long-term immunity.
   • Persons with HIV infection or severe immunodeficiency who present with contaminated wounds; give TIG regardless of prior tetanus vaccination history.
4. Already protected: Persons who have completed a primary series of tetanus toxoid-containing vaccine AND received one dose of tetanus toxoid-containing vaccine within the past five years, do not require vaccine or TIG for wound management.
5. Timing:
   • Clean or minor wounds: Booster dose of tetanus toxoid-containing vaccine if less than 10 years since last dose.
   • All other wounds (contaminated): Booster dose of tetanus toxoid-containing vaccine if 5 years or more since last dose.
6. Arthus reaction: Persons with a history of an Arthus reaction after a tetanus toxoid–containing vaccine should not receive another tetanus-toxoid–containing vaccine until more than 10 years after the most recent dose, regardless of wound type.