People with uncertain vaccination history and a tetanus-prone wound are recommended to receive tetanus-containing vaccine and tetanus immunoglobulin
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.
|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|
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
- 250 IU if ≤24 hours since injury
- 500 IU if >24 hours since injury
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.