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Determine tetanus vaccination and TIG needs based on wound type and immunization history
0.5 mL IM (deltoid) - Adults and children ≥7 years
0.5 mL IM (deltoid) - Preferred if no prior Tdap or >10 years since last Tdap
250 units IM - Give at different site from vaccine. Provides immediate passive immunity.
| Vaccination History | Clean, Minor Wound | All Other Wounds* |
|---|---|---|
| Unknown or <3 doses | Td or Tdap | Td or Tdap + TIG |
| ≥3 doses, last dose <5 years | No prophylaxis | No prophylaxis |
| ≥3 doses, last dose 5-10 years | No prophylaxis | Td or Tdap |
| ≥3 doses, last dose >10 years | Td or Tdap | Td or Tdap + TIG |
*Tetanus-prone wounds: contaminated, puncture, crush injury, >6 hours old, devitalized tissue, burns, frostbite
Tetanus is a serious bacterial infection caused by Clostridium tetani, which produces a neurotoxin causing muscle spasms and rigidity. It has a mortality rate of 10-20% even with treatment. Tetanus spores are found in soil, dust, and animal feces. Prophylaxis with vaccination and/or immunoglobulin can prevent this life-threatening disease.
Both protect against tetanus and diphtheria. Tdap also protects against pertussis (whooping cough). Adults should receive Tdap at least once, preferably as a booster. Pregnant women should receive Tdap during each pregnancy (27-36 weeks). After initial Tdap, subsequent boosters can be Td or Tdap.
TIG provides immediate passive immunity and is needed for tetanus-prone wounds in patients with unknown/incomplete vaccination history or when the last dose was >10 years ago. TIG must be given at a different site from the vaccine. The standard dose is 250 units IM (can increase to 500 units for severe contamination).
After completing the primary series (3 doses), adults need a booster every 10 years. For tetanus-prone wounds, a booster is given if it's been >5 years since the last dose. Children receive DTaP at 2, 4, 6, 15-18 months, and 4-6 years, then Tdap at 11-12 years.
Tetanus-prone wounds include: puncture wounds (especially deep), contamination with soil/dirt/feces/saliva, wounds >6 hours old before treatment, crush injuries, wounds with devitalized tissue, burns, frostbite, and wounds from non-sterile objects. Tetanus bacteria thrive in anaerobic (low oxygen) environments.
Common side effects include injection site pain, redness, swelling, mild fever, headache, and fatigue. Severe allergic reactions are rare. Local reactions may be more common with frequent boosters. If you have a history of severe reaction to tetanus vaccine, discuss alternatives with your healthcare provider.
This tetanus prophylaxis calculator provides guidance based on CDC recommendations. Individual patient factors may require modification of these guidelines. Always consider patient allergies, prior adverse reactions, pregnancy status, and immunocompromised state. Proper wound care including cleaning, debridement, and appropriate antibiotic therapy are essential components of tetanus prevention. Consult infectious disease or public health specialists for complex cases.