From the Guidelines
Tetanus prophylaxis should be guided by the patient's vaccination history and the type of wound, with tetanus toxoid (Td/Tdap) and tetanus immune globulin (TIG) administered as necessary to prevent tetanus infection, as recommended by the Advisory Committee on Immunization Practices (ACIP) 1.
Tetanus Prophylaxis Guidelines
The guidelines for tetanus prophylaxis are based on the patient's vaccination history and the type of wound.
- For clean, minor wounds in patients with a complete primary tetanus vaccination series and a booster within the past 10 years, no additional prophylaxis is needed.
- For dirty wounds (contaminated with soil, feces, saliva, or puncture wounds) in patients with complete vaccination but whose last booster was over 5 years ago, a tetanus toxoid booster (Td or Tdap) should be given.
- For patients with incomplete or unknown vaccination history, tetanus toxoid should be administered for any wound, and TIG (250-500 units IM) should be added for dirty wounds.
Administration of TIG and Tetanus Toxoid
When administering both TIG and tetanus toxoid, use separate syringes and injection sites, as recommended by the ACIP 1.
Complete Primary Immunization
Complete primary immunization consists of three doses: initial dose, second dose 4-8 weeks later, and third dose 6-12 months after the second, which effectively prevents tetanus, a disease caused by Clostridium tetani exotoxin with a high mortality rate if infection develops 1.
Updated Recommendations
The ACIP has updated its recommendations to allow use of either Td or Tdap where previously only Td was recommended, increasing provider point-of-care flexibility 1.
From the FDA Drug Label
TENIVAC is a vaccine indicated for active immunization for the prevention of tetanus and diphtheria in persons 7 years of age and older. (1)
The guidelines for tetanus and diphtheria vaccination are to administer the vaccine to persons 7 years of age and older for the prevention of tetanus and diphtheria 2.
- The vaccine is indicated for active immunization.
- It is used for the prevention of tetanus and diphtheria.
- The recommended age group for vaccination is 7 years of age and older 2.
From the Research
Tetanus and Tig Guidelines
- Tetanus remains a significant problem in many countries, with high mortality rates in settings where access to mechanical ventilation and intensive care facilities is limited 3.
- The administration of tetanus antitoxin by the intramuscular route is recommended for the treatment of tetanus, but intrathecal administration of antitoxin may be beneficial 3.
- Accurate determination of immunoglobulin G (IgG) antibody to tetanus toxoid is important for evaluating the immunogenicity of tetanus toxoid vaccines and determining immune competence in individual patients 4.
- Different enzyme-linked immunosorbent assays (ELISAs) for IgG antibodies to tetanus toxoid have varying performance characteristics, which can lead to disparities in reported results 4.
Vaccine Development and Detection
- A recombinant tetanus toxin subunit vaccine has been developed, which provides complete protection against tetanus toxin challenge in mice 5.
- The vaccine is based on the Hc domain of the tetanus toxin and has been shown to be immunogenic and protective in animal models 5.
- A fluorescent tetanus human IgG-AuNC-based immunochromatography test strip has been developed for the detection of tetanus toxoid, which has a detection limit of 0.03 μg/mL 6.
- A monoclonal antibody sandwich ELISA has been developed for the quality control of human and animal tetanus vaccines, which can measure the relative amount and quality of tetanus toxoid 7.
Clinical Practice and Research
- The performance of different ELISAs for IgG antibodies to tetanus toxoid can impact clinical practice, with varying results leading to different interpretations of immune competence 4.
- The development of new vaccines and detection methods, such as the recombinant tetanus toxin subunit vaccine and the fluorescent tetanus human IgG-AuNC-based immunochromatography test strip, can improve the diagnosis and treatment of tetanus 5, 6.
- The use of monoclonal antibody sandwich ELISA for the quality control of tetanus vaccines can help ensure the consistency and quality of vaccine batches 7.