Stephen J. Schueler, M.D.

Overview Incidence Risk Factors Symptoms Evaluation Treatment specialist Prevention Outlook Complications Underlying Cause Transmission

Tetanus Prevention

Prevention of tetanus includes:

  • Routine tetanus vaccination.
  • Appropriate care of all penetrating skin wounds.
    • Clean wounds thoroughly as soon as possible after an injury
    • Administer tetanus vaccine and tetanus immune globulin when indicated (see below)

Vaccination Options
  • Tetanus booster (Td):
    • Td is a tetanus-diphtheria vaccine given to adolescents and adults as a booster shot every 10 years.
    • Tdap is similar to Td but also containing protection against pertussis. A single dose of Tdap is recommended for adolescents 11 or 12 years of age.
    • Td can be given up to 72 hours after a wound if someone has had 3 or more tetanus vaccines (DTaP) in the past.
  • Tetanus Immune Globulin (TIG)
    • TIG contains antibody to tetanus toxin. It can bind to the toxin and deactivate it. TIG may be administered (in addition to a tetanus booster) to those who are not up-to-date with their tetanus vaccinations.

Tetanus wound management is based on two factors:
  • The person's tetanus vaccine status (i.e. have they received prior tetanus vaccination?)
    • To complete the tetanus series, 1 dose of DTaP vaccine is recommended at each of the following ages: 2 months, 4 months, 6 months, 15-18 months, 4-6 years old.
    • Td is a tetanus booster that is given to adolescents and adults as a booster shot every 10 years, although Tdap may be given instead.
  • The degree of wound contamination:
    • Skin wounds that must be considered include puncture wounds, lacerations, and abrasions.
    • All puncture wounds with the exception of clean, minor, household wounds are considered to be dirty.
    • All bites should be considered contaminated and thus require tetanus vaccine.
    • Wounds that occur outdoors are considered to be dirty wounds.
    • Wounds that contain dirt or soil have the highest tetanus infection risk.

Tetanus Vaccine and TIG Recommendations
HistoryClean, Minor WoundOther Wounds
< 3 boostersgive Tdgive Td + TIG
3 boosterspossible Tdpossible Td

Clean and minor wounds may need a booster if it has been more than 10 years since the last tetanus vaccine. Other wounds may need a booster if it has been more than 5 years since last tetanus vaccine.

Continue to Tetanus Outlook

Last Updated: Nov 8, 2010 References
Authors: Stephen J. Schueler, MD; John H. Beckett, MD; D. Scott Gettings, MD
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PubMed Tetanus References
  1. Attygalle D, Rodrigo N. New trends in the management of tetanus. Expert Rev Anti Infect Ther. 2004 Feb;2(1):73-84. [15482173]
  2. Hsu SS, Groleau G. Tetanus in the emergency department: a current review. J Emerg Med. 2001 May;20(4):357-65. [11348815]
  3. Rhee P, Nunley MK, Demetriades D, Velmahos G, Doucet JJ. Tetanus and trauma: a review and recommendations. J Trauma. 2005 May;58(5):1082-8. [15920431]
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