Tetanus prophylaxis

Background
  • Incubation Period: 1dy - 2 mo
  • 70% of wounds are prone to tetanus. These include contaminated wounds or puncture wounds but 30% are clean wounds. There are also case reports of surgically created wounds with autoclaved instruments resulting in tetanus [1]

Prophylaxis
An Algorithm for Tetanus Prophylaxis in Adults [2]
  • Past vac unknown or <3 total
    • Clean wound → Td
    • Dirty wound → Td & TIG
  • Past vac 3 or more total
    • Clean wound → Td Q10yrs
    • Dirty wound → Td Q5yrs

Tetanus Vaccine Selection Guide
Age If No Pertussis Contraindications If Pertussis Contraindicated Comments
2mo - 7yrs DTaP DT DT available from pharmacy
7yrs - 10yrs Td Td
10yrs Tdap(Adacel)^ Td ^Off label use, but appears safe and immunogenic
11yrs - 16yrs Tdap(Adacel) Td
16yrs - 65 Tdap(Adacel)^^ Td ^^Use Td if patient is known to have received prior Tdap
65yrs + Td
 Td
 Consider TIG for tetanus prone wound plus Td(tetanus immune globulin)

Caveats

  • Adolescents who have already gotten a booster dose of Td are encouraged to get a dose of Tdap as well. Waiting 5 years after their last Td is encouraged but not required. A period of at least 2 years between Td and Tdap is recommended in these cases.
  • Pregnancy is not a contraindication to Tdap.
  • Stable neurologic disorders and family history of vaccine reactions are not contraindications to receiving these vaccines.
  • No vaccine has ever been shown to play any role in the development of autism or autism spectrum disorders.

See Also

References
  1. CDC. Tetanus surveillance – United States. 2001-2008. MMWR 2011,60(No. 12) Fulltext
  2. Diphtheria, tetanus, and pertussis: recommendations for vaccine use and other preventive measures. Recommendations of the Immunization Practices Advisory committee (ACIP). MMWR Recomm Rep. 1991;40(RR-10):1-28.
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