Summary Guide to Tetanus Prophylaxis in Routine Wound Management

A summary guide to examining wounds for possible tetanus prophylaxis.

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1. A primary series consists of a minimum of 3 doses of tetanus- and diphtheria- containing vaccine (DTaP/DTP/Tdap/DT/Td).
2. Age-appropriate vaccine:
   
   • DTaP for infants and children 6 weeks up to 7 years of age (or DT pediatric if pertussis vaccine is contraindicated);
   • Tetanus-diphtheria (Td) toxoid for persons 7 through 9 years of age and 65 years of age and older;
   • Tdap for persons 11 through 64 years of age if using Adacel* or 10 years of age and older if using Boostrix*, unless the person has received a prior dose of Tdap.*
3. No vaccine or TIG is recommended for infants younger than 6 weeks of age with clean, minor wounds. (And no vaccine is licensed for infants younger than 6 weeks of age.)
4. Tdap* is preferred for persons 11 through 64 years of age if using Adacel* or 10 years of age and older if using Boostrix* who have never received Tdap. Td is preferred to tetanus toxoid (TT) for persons 7 through 9 years, 65 years and older, or who have received a Tdap previously. If TT is administered, and adsorbed TT product is preferred to fluid TT.
   (All DTaP/DTP/Tdap/DT/Td products contain adsorbed tetanus toxoid.)
5. Give TIG 250 U IM for all ages. It can and should be given simultaneously with the tetanus-containing vaccine.
6. For infants younger than 6 weeks of age, TIG (without vaccine) is recommended for ”dirty” wounds (wounds other than clean, minor).
7. Persons who are HIV positive should receive TIG regardless of tetanus immunization history.

* Boostrix (GSK) is licensed for persons 10 through 64 years.
Adacel (Sanofi) is licensed for persons 11 through 64 years.
(1) Brand names are used for the purpose of clarifying product characteristics and are not in any way an endorsement of either product.