People with uncertain vaccination history and a tetanus-prone wound are recommended to receive tetanus-toxoid 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. This includes women who are pregnant or breastfeeding. They should also receive an appropriate tetanus-toxoid 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 |
|
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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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-toxoid 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-toxoid vaccine at the same time in the opposite limb with a separate syringe. These people should complete the full course of vaccination using tetanus-toxoid vaccines.