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

DTPa, DTPa combinations, dT, dTpa, 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 uncertainb

Uncertain

Clean, minor wounds

Yes

No

<3 doses or uncertainb

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

Page history

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