If a person of any age has a tetanus-prone wound and there is any doubt about the person’s tetanus immunisation status, they should receive tetanus immunoglobulin as soon as possible. They should also receive an appropriate tetanus-containing vaccine. This combination provides both active and passive protection.

Tetanus immunoglobulin is not needed for clean, minor cuts, even if the person has no history of tetanus vaccination.

Table. Guide to tetanus prophylaxis in wound management shows appropriate tetanus prophylaxis measures in wound management, including using tetanus immunoglobulin.

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

Use of tetanus immunoglobulin 

People who have a tetanus-prone wound should receive tetanus immunoglobulin for passive protection if either: 

  • they have not previously received 3 or more doses of a tetanus-containing vaccine, or 
  • there is doubt about their tetanus vaccination status, or 
  • they have a humoral immune deficiency or have HIV 

Tetanus immunoglobulin provides immediate protection that lasts for 3–4 weeks.12 

Give tetanus immunoglobulin by intramuscular injection as soon as practicable after the injury. The recommended dose of tetanus immunoglobulin is:

  • 250 IU if ≤24 hours since injury
  • 500 IU if >24 hours since injury 

Tetanus immunoglobulin is viscous. Use a 21 gauge needle for adults. For children, give tetanus immunoglobulin slowly using a 23 gauge needle. 

People receiving tetanus immunoglobulin should receive a tetanus-containing vaccine at the same time in the opposite limb with a separate syringe. These people should complete the full course of vaccination using tetanus-containing vaccines.

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
IU
international units