No, TIG and ATS are NOT the same
Tetanus Immune Globulin (TIG) is human-derived antibody and is the product of choice for passive tetanus immunization, while Antitetanus Serum (ATS) is equine (horse)-derived antitoxin that is now obsolete in modern practice due to severe allergic reactions. 1
Key Differences
Source and Safety Profile
TIG (Human Tetanus Immune Globulin): Derived from human plasma donors with high tetanus antibody titers. Causes few adverse reactions and provides longer protection (approximately 4 weeks) 2, 3
ATS (Equine Antitetanus Serum): Derived from horse or bovine serum. Historically caused severe allergic manifestations in 5-30% of recipients, even in patients with negative skin tests prior to administration 2
Clinical Recommendation
If passive immunization is needed, human tetanus immune globulin (TIG) is the product of choice 1. The current ACIP guidelines exclusively recommend TIG for wound management - ATS is not mentioned as a treatment option in modern protocols 4.
Practical Application
Standard Dosing
- TIG: 250 units intramuscularly for prophylaxis in wounds of average severity 1, 5, 1
- When TIG and tetanus toxoid are given together, use separate syringes at different anatomical sites 4
When TIG is Indicated
For patients with unknown or <3 doses of tetanus vaccination who have:
- Contaminated wounds (dirt, feces, soil, saliva)
- Puncture wounds
- Avulsions
- Wounds from missiles, crushing, burns, or frostbite 4
Special Considerations
- HIV-infected or severely immunodeficient patients with contaminated wounds should receive TIG regardless of vaccination history 4
- If TIG is unavailable, intravenous immune globulin may be substituted 5
Common Pitfall
Do not use equine ATS in modern practice. While some older research examined intrathecal ATS administration 6, 7, this is not standard care and TIG remains the recommended product for both intramuscular prophylaxis and any experimental intrathecal protocols.
Human-derived TIG eliminates the foreign protein reactions that made equine ATS problematic and provides superior duration of protection 2, 3.