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-toxoid vaccine.
These people may not have developed or maintained adequate immunity to tetanus, despite vaccination.
See 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 |
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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-toxoid vaccine. b People who have no documented history of a complete primary vaccination course (3 doses) with a tetanus-toxoid 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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