From the Guidelines
Tetanus immune globulin (TIG) is indicated after a wound when the patient has an unknown or less than 3 doses of adsorbed tetanus toxoid–containing vaccines, or if the wound is contaminated, regardless of the patient's vaccination history, as stated in the guidelines by the Advisory Committee on Immunization Practices (ACIP) 1.
Indications for TIG
- Unknown or less than 3 doses of adsorbed tetanus toxoid–containing vaccines
- Contaminated wounds, such as those with dirt, feces, soil, or saliva; puncture wounds; avulsions; wounds from crushing injuries, burns, or frostbite; and wounds with devitalized tissue
- Immunocompromised patients, including those with HIV infection or severe immunodeficiency, who have contaminated wounds
Administration of TIG
- The standard dose is 250-500 units given intramuscularly as soon as possible after the injury, ideally within 24 hours but it can still be beneficial if given within 72 hours
- TIG should be administered at a different site from the tetanus toxoid vaccine, which should also be given to initiate or complete active immunization
Importance of TIG
- Provides immediate passive immunity against tetanus toxin by delivering preformed antibodies
- Covers the incubation period for tetanus while the body develops active immunity from the vaccine, lasting approximately 3-4 weeks
- Particularly important for immunocompromised patients who may not respond adequately to the vaccine alone, as noted in the guidelines 1
From the Research
Indications for Tetanus Immunoglobulin (TIG) after a Wound
- TIG is indicated for individuals who have not been fully vaccinated against tetanus or whose vaccination status is unknown 2, 3
- It is also recommended for individuals who have been fully vaccinated but have a dirty or tetanus-prone wound, such as a wound contaminated with dirt, feces, or saliva 2, 3
- The decision to administer TIG should be based on a thorough history, physical exam, and assessment of the wound, rather than solely on the patient's tetanus antibody level 2
- TIG can be administered intramuscularly or intrathecally, although the latter is still being studied and its effectiveness and safety are not yet fully established 3
Factors to Consider when Administering TIG
- The patient's vaccination history and status should be taken into account when deciding whether to administer TIG 2, 4
- The type and severity of the wound should also be considered, as well as the patient's overall health status 2, 3
- The levels of anti-tetanus toxoid IgG antibodies in intravenous gamma globulin (IVIG) may vary, and IVIG may be an acceptable alternative to TIG in some cases 5
Laboratory Tests for Tetanus Antibody Levels
- Enzyme-linked immunosorbent assays (ELISAs) can be used to measure IgG antibodies to tetanus toxoid, but the performance characteristics of these assays can vary depending on the manufacturer 4
- The results of these assays should be interpreted with caution and in the context of the patient's clinical presentation and vaccination history 2, 4