Is a Tetanus (lockjaw) vaccination required after a laceration?

From the Guidelines

A tetanus shot is recommended after a laceration if you haven't had a tetanus booster within the past 5 years for dirty wounds or 10 years for clean wounds. The standard tetanus vaccine given is Tdap (tetanus, diphtheria, and pertussis) or Td (tetanus and diphtheria) depending on your vaccination history, as stated in the guidelines by the Advisory Committee on Immunization Practices (ACIP) 1. For most adults, a 0.5 mL dose is administered intramuscularly in the deltoid muscle. If you've never been vaccinated against tetanus or your vaccination status is unknown, you may also need tetanus immune globulin (TIG) along with the vaccine, especially for contaminated wounds.

Key Considerations

• The decision to administer a tetanus toxoid–containing vaccine should be based on the primary vaccination history for tetanus, with consideration of the time elapsed since the last tetanus toxoid–containing vaccine dose 1.
• For dirty wounds, a booster dose of tetanus toxoid vaccine should be administered if more than 5 years have elapsed since the last dose, and for clean wounds, if more than 10 years have elapsed 1.
• Tdap is preferred over Td if the former has not been previously given, especially for persons aged ≥11 years 1.

Administration and Side Effects

• The vaccine is typically administered intramuscularly in the deltoid muscle.
• Mild side effects like soreness at the injection site, low-grade fever, or fatigue may occur but usually resolve within a day or two.
• It's crucial to follow the guidelines for tetanus prophylaxis in routine wound management to prevent tetanus, a severe and potentially fatal disease 1.

From the FDA Drug Label

For active tetanus immunization in wound management of patients 7 years of age and older, a preparation containing tetanus and diphtheria toxoids is preferred instead of single-antigen tetanus toxoid to enhance diphtheria protection. The need for active immunization with a tetanus toxoid-containing preparation, with or without passive immunization with Tetanus Immune Globulin (TIG) (Human) depends on both the condition of the wound and the patient's vaccination history. Table 1: Guide for use of Tetanus and Diphtheria Toxoids Adsorbed (Td) for Tetanus Prophylaxis in Routine Wound Management in Persons 7 Years of Age and Older History of Adsorbed Tetanus Toxoid (Doses) | Clean, Minor Wounds | All Other Wounds* Td | TIG | Td | TIG Unknown or < three | Yes | No | Yes | Yes ≥ Three† | No‡ | No | No§ | No

Tetanus Shot After Laceration: The decision to administer a tetanus shot after a laceration depends on the condition of the wound and the patient's vaccination history.

• For clean, minor wounds, a tetanus shot (Td) is recommended if the patient has an unknown or incomplete vaccination history.
• For all other wounds (e.g., contaminated, puncture, or traumatic wounds), a tetanus shot (Td) and Tetanus Immune Globulin (TIG) are recommended if the patient has an unknown or incomplete vaccination history.
• If the patient has a complete vaccination history (≥ three doses), a tetanus shot (Td) is recommended if it has been more than 10 years since the last dose for clean, minor wounds, and if it has been more than 5 years since the last dose for all other wounds. 2

From the Research

Tetanus Shot After Laceration

• The need for a tetanus shot after a laceration depends on the individual's immunization history, as stated in the study 3.
• Adults should receive a tetanus toxoid booster if it has been more than 10 years since their last immunization, according to the recommendations in 3.
• There is no urgency for the administration of tetanus toxoid in the acute setting, as it provides protection against future injuries, not the current one, as mentioned in 3.
• Tetanus immunoglobulin should be reserved for patients with wounds who had never received primary immunization against tetanus, as stated in 3.
• The administration of tetanus immune globulin (TIG) with tetanus-diphtheria vaccine may interfere with the immune response, as shown in the comparative clinical trial in 4.
• The World Health Organization (WHO) provides recommendations on the use of tetanus toxoid vaccines, including the optimal timing of booster doses, as outlined in 5.
• Research is ongoing to develop new tetanus vaccines, such as genetically detoxified tetanus toxin, which may offer improved safety and efficacy, as described in 6.