From the Guidelines
For a patient with a foot injury from a clean wood piece who received their last tetanus vaccine 12 years ago, I would give Tetanus toxoid (option A). Since this is a clean, minor wound and the patient has previously been immunized against tetanus (though more than 10 years ago), a tetanus toxoid booster alone is sufficient, as indicated in the guide to tetanus prophylaxis in routine wound management 1. Key points to consider in this scenario include:
- The type of wound: clean and minor
- The patient's vaccination history: last tetanus vaccine 12 years ago
- The recommendations for tetanus prophylaxis: according to the guide, for individuals with ≥3 doses of adsorbed tetanus toxoid–containing vaccines and a clean, minor wound, a booster dose of tetanus toxoid is recommended if it has been ≥10 years since the last tetanus toxoid–containing vaccine dose 1. Tetanus immunoglobulin is not necessary for clean wounds in previously immunized individuals, even when the last dose was more than 10 years ago, as per the guidelines 1. The toxoid booster will stimulate the patient's immune system to produce protective antibodies against tetanus. Tetanus antiserum is an outdated term, and the combination of toxoid plus immunoglobulin would be excessive for this clean injury scenario. The booster dose should be administered as soon as possible after the injury to ensure adequate protection, following the recommendations of the Advisory Committee on Immunization Practices (ACIP) 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 ≥ Three† No‡ No No§ ‡ Yes, if >10 years since last dose.
The patient has a clean, minor wound and has received the last dose of tetanus vaccine 12 years ago. According to the guidelines, for a clean, minor wound, and the patient has received ≥ Three doses, Td should be given if >10 years have passed since the last dose. Therefore, the patient should receive Tetanus toxoid (Td). Since the patient's wound is clean and minor, and the last dose was more than 10 years ago, Tetanus Immunoglobulin (TIG) is not necessary. The correct answer is: A. Tetanus toxoid (minor, clean, last > 10y) 2
From the Research
Tetanus Prophylaxis for a Patient with a Foot Injury
- The patient has a foot injury caused by a piece of clean wood and their last dose of tetanus vaccine was 12 years ago.
- According to the studies, tetanus prophylaxis is recommended for patients with wounds, especially if their tetanus vaccination is not up-to-date 3, 4.
- The World Health Organization (WHO) provides guidance on the use of tetanus toxoid (TT) vaccines, including recommendations for booster doses 5.
- For a patient with a clean wound and a tetanus vaccination history of more than 10 years, the recommended prophylaxis is tetanus toxoid (TT) 6, 7.
- However, the patient's injury is caused by a clean piece of wood, which is considered a low-risk wound, but the patient's tetanus vaccination is not up-to-date.
- Based on the studies, the patient should receive tetanus toxoid (TT) as prophylaxis, and tetanus immunoglobulin (TIG) may not be necessary in this case 7, 3.
- The correct answer is: