Does a rabbit bite require a Tetanus Toxoid (TT) shot?

Tetanus Prophylaxis for Rabbit Bites

A rabbit bite does not inherently require a tetanus toxoid (TT) shot, but tetanus prophylaxis should be administered based on the patient's vaccination history and the nature of the wound, not the animal species that caused it.

Decision Algorithm for Tetanus Prophylaxis

Step 1: Assess Vaccination History

• Complete primary series (≥3 doses) with last dose <5 years ago: No tetanus prophylaxis needed 1
• Complete primary series with last dose 5-10 years ago: Administer tetanus toxoid-containing vaccine (Tdap preferred if not previously received, otherwise Td) 1
• Complete primary series with last dose >10 years ago: Administer tetanus toxoid-containing vaccine (Tdap preferred if not previously received, otherwise Td) 1
• Unknown or incomplete vaccination history (<3 doses): Administer tetanus toxoid-containing vaccine AND tetanus immune globulin (TIG) 1, 2

Step 2: Assess Wound Characteristics

• Clean, minor wound: Follow Step 1 guidelines, except if complete vaccination with last dose >10 years ago, then administer tetanus toxoid 1
• All other wounds (contaminated with dirt, feces, soil, saliva; puncture wounds; avulsions; wounds from crushing, burns, frostbite):
  • If complete vaccination with last dose >5 years ago, administer tetanus toxoid 1
  • If unknown/incomplete vaccination, administer both tetanus toxoid AND TIG 1

Important Considerations

Vaccine Selection

• For patients ≥11 years who have never received Tdap, use Tdap rather than Td 1, 2
• For patients who have already received Tdap, use Td for subsequent tetanus prophylaxis 1
• For pregnant women, Tdap is preferred 1, 2

Administration Guidelines

• When both TIG and tetanus toxoid are indicated, administer using separate syringes at different anatomical sites 1, 2, 3
• TIG should be administered intramuscularly, never intravenously 3
• The standard prophylactic dose of TIG is 250 IU 2, 3

Special Situations

• Patients with HIV or severe immunodeficiency with contaminated wounds should receive TIG regardless of vaccination history 1
• Patients with history of Arthus reaction to previous tetanus toxoid-containing vaccine should not receive tetanus toxoid until >10 years after the most recent dose 1

Wound Care

• Proper wound cleaning and debridement are as critical as immunization for tetanus prevention 2
• Immediate and thorough wound cleaning with water or diluted iodopovidone solution is essential 2

Cautions and Pitfalls

1. Don't assume rabbit bites are low risk: While rabbits are not typically associated with tetanus, the risk is determined by wound characteristics and vaccination status, not the animal species 2

2. Don't delay prophylaxis: Administer appropriate tetanus prophylaxis promptly based on vaccination history and wound characteristics 1, 2

3. Don't rely solely on tetanus toxoid for immediate protection: In unvaccinated or incompletely vaccinated individuals with tetanus-prone wounds, both tetanus toxoid AND TIG are needed 1, 4

4. Don't assume previous vaccination provides absolute protection: Cases of tetanus have been reported in previously immunized individuals 5, 4

5. Don't administer TIG intravenously: This can cause precipitous blood pressure drop and anaphylaxis-like reactions 3

The evidence clearly shows that tetanus prophylaxis decisions should be based on vaccination history and wound characteristics rather than the species of animal that caused the bite. Following these guidelines ensures appropriate protection against tetanus while avoiding unnecessary administration of tetanus toxoid or immunoglobulin.