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Recommendations

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.

See Table. Guide to tetanus prophylaxis in wound management.

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
  1. 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.
  2. 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
Related diseases
Tetanus

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