People with a tetanus-prone wound and a humoral immune deficiency (including HIV) are recommended to receive tetanus immunoglobulin

People with a humoral immune deficiency and people with HIV (regardless of CD4⁺ count) are recommended to receive tetanus immunoglobulin if they have a tetanus-prone injury. This is regardless of the time since their last dose of tetanus-containing vaccine.

These people may not have developed or maintained adequate immunity to tetanus, despite vaccination.

Table. Guide to tetanus prophylaxis in wound management

History of tetanus vaccination	Time since last dose	Type of wound	, combinations, , , as appropriate	Tetanus immunoglobulin
≥3 doses	<5 years	Clean, minor wounds	No	No
≥3 doses	<5 years	All other wounds	No	No (unless person has immunodeficiency)^a
≥3 doses	5–10 years	Clean, minor wounds	No	No
≥3 doses	5–10 years	All other wounds	Yes	No (unless person has immunodeficiency)^a
≥3 doses	>10 years	Clean, minor wounds	Yes	No
≥3 doses	>10 years	All other wounds	Yes	No (unless person has immunodeficiency)^a
<3 doses or uncertain^b	Uncertain	Clean, minor wounds	Yes	No
<3 doses or uncertain^b	Uncertain	All other wounds	Yes	Yes

a.Give tetanus immunoglobulin to people with a humoral immune deficiency and people with HIV (regardless of CD4⁺ count) if they have a tetanus-prone injury. This is regardless of the time since their last dose of tetanus-containing vaccine.

b. People who have no documented history of a complete primary vaccination course (3 doses) with a tetanus-containing vaccine should receive all missing doses and must receive tetanus immunoglobulin for tetanus-prone wounds. See Catch-up vaccination.

Source: Cox et al,⁶ Fraser,⁷ Lucas and Willis,⁸ McComb,⁹ Smith et al,¹⁰ Trinca¹¹

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Last updated:

4 June 2018

Last reviewed:

4 June 2018

Definitions

DTPa: diphtheria-tetanus-acellular pertussis vaccine
dT: diphtheria-tetanus vaccine for use in adults
dTpa: diphtheria-tetanus-acellular pertussis vaccine, reduced antigen content formulation

People with a tetanus-prone wound and a humoral immune deficiency (including HIV) are recommended to receive tetanus immunoglobulin

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