Tetanus prophylaxis

Background

• Incubation Period: 1dy - 2 mo
• 70% of wounds are prone to tetanus. These include contaminated wounds or puncture wounds but 30% are clean wounds. There are also case reports of surgically created wounds with autoclaved instruments resulting in tetanus

Prophylaxis

• Past vac unknown or <3 total
  • Clean wound → Td
  • Dirty wound → Td & TIG
• Past vac 3 or more total
  • Clean wound → Td Q10yrs
  • Dirty wound → Td Q5yrs

Tetanus Vaccine Selection Guide

Age	If No Pertussis Contraindications	If Pertussis Contraindicated	Comments
2mo - 7yrs	DTaP	DT	DT available from pharmacy
7yrs - 10yrs	Td	Td
10yrs	Tdap(Adacel)^	Td	^Off label use, but appears safe and immunogenic
11yrs - 16yrs	Tdap(Adacel)	Td
16yrs - 65	Tdap(Adacel)^^	Td	^^Use Td if patient is known to have received prior Tdap
65yrs +	Td	Td	Consider TIG for tetanus prone wound plus Td(tetanus immune globulin)

Caveats

• Adolescents who have already gotten a booster dose of Td are encouraged to get a dose of Tdap as well. Waiting 5 years after their last Td is encouraged but not required. A period of at least 2 years between Td and Tdap is recommended in these cases.
• Pregnancy is not a contraindication to Tdap. The only true contraindication to tetanus immunization is a history of neurologic or severe hypersensitivity to a previous dose.
• Stable neurologic disorders and family history of vaccine reactions are not contraindications to receiving these vaccines.
• No vaccine has ever been shown to play any role in the development of autism or autism spectrum disorders.

See Also

• Tdap (Pertussis Vaccine) for new recommendations from CDC
• Tetanus (Acute)