Is tetanus prophylaxis usually administered for cat scratches in the Emergency Department (ED)?

From the Guidelines

Tetanus prophylaxis is not routinely given for cat scratches in the Emergency Department, but it should be considered based on the patient's tetanus immunization status and wound characteristics. Cat scratches typically do not pose a significant risk for tetanus infection because tetanus-causing bacteria (Clostridium tetani) primarily live in soil, dust, and animal feces rather than on cats' claws. Instead, cat scratches are more concerning for cat scratch disease (caused by Bartonella henselae) or other bacterial infections. For cat scratches, standard wound care including thorough cleaning with soap and water is recommended.

Key Considerations for Tetanus Prophylaxis

• The patient's tetanus immunization status: if the patient has not received a tetanus toxoid-containing vaccine dose within 5-10 years, tetanus prophylaxis should be considered 1.
• Wound characteristics: if the wound is contaminated with dirt or feces, tetanus prophylaxis should be considered 1.

Administration of Tetanus Prophylaxis

If tetanus prophylaxis is indicated, a tetanus toxoid-containing vaccine (Tdap or Td) would be administered. The decision to provide tetanus prophylaxis should be based on the patient's immunization history and wound characteristics rather than the fact that it's specifically a cat scratch. According to the most recent guidelines, Tdap is preferred for persons who have not previously received Tdap or whose Tdap history is unknown 1.

Summary of Recommendations

• Tetanus prophylaxis is not routine for cat scratches
• Consider tetanus prophylaxis based on immunization status and wound characteristics
• Administer Tdap or Td if tetanus prophylaxis is indicated
• Follow standard wound care for cat scratches, including thorough cleaning with soap and water.

From the Research

Tetanus Prophylaxis for Cat Scratches

• Tetanus prophylaxis is not usually administered for cat scratches in the Emergency Department (ED) unless the patient's vaccination history indicates a need for it 2, 3.
• The decision to administer tetanus prophylaxis depends on the patient's vaccination history and the severity of the wound 4, 5, 3.
• Studies have shown that tetanus prophylaxis is often misused and misunderstood in the acute injury setting, and that it is not necessary to administer it urgently in the ED 3.
• The use of rapid immunoassays, such as the Tétanos Quick Stick (TQS), can help improve the evaluation of tetanus immunity and reduce unnecessary prophylactic measures 4, 5.

Factors Influencing Tetanus Prophylaxis

• The patient's vaccination history is a crucial factor in determining the need for tetanus prophylaxis 6, 4, 5, 3.
• The severity of the wound and the presence of certain demographic characteristics, such as age and sex, can also influence the decision to administer tetanus prophylaxis 4, 2, 3.
• The use of tetanus immunoglobulin is typically reserved for patients with wounds who have never received primary immunization against tetanus 3.