What vaccine and immunoglobulin should a 7-year-old child with no prior tetanus vaccination receive after sustaining a contaminated deep cut?

Tetanus Prophylaxis for Unvaccinated Child with Contaminated Deep Wounds

The 7-year-old child with contaminated deep cuts and no prior tetanus vaccination should receive tetanus immunoglobulin (TIG) AND diphtheria tetanus acellular pertussis (DTaP) vaccine series (option C). 1, 2, 3

Rationale for This Recommendation

Assessment of Risk Factors

• The patient has multiple risk factors for tetanus:
  • Contaminated deep wounds (high-risk wounds)
  • No history of tetanus vaccination (unimmunized status)
  • Age 7 years (still within age range for DTaP)

Appropriate Prophylaxis Components

1. Tetanus Immunoglobulin (TIG)

   • Indicated for immediate passive protection in unvaccinated individuals with contaminated wounds 1, 3
   • Standard dose: 250 units intramuscularly as a single dose 2, 3
   • Provides immediate antibody protection while active immunity develops
   • Must be administered at a different site from the tetanus toxoid-containing vaccine 1

2. DTaP Vaccine Series

   • DTaP is the appropriate tetanus toxoid-containing vaccine for children <7 years old 1, 2
   • Initiates active immunity against tetanus, diphtheria, and pertussis
   • Complete series needed for long-term protection

Why Other Options Are Incorrect

• Option A (Booster tetanus toxoid vaccine only): Inadequate for unvaccinated individuals with contaminated wounds; passive immunity with TIG is also needed 1, 3

• Option B (Booster tetanus toxoid and TIG): Incorrect terminology; an unvaccinated child needs a primary series, not a "booster" 1

• Option D (TIG only): Insufficient for long-term protection; active immunization must be initiated simultaneously 1, 3

Implementation Details

1. Administration Timing:

   • Administer both TIG and DTaP immediately (same day)
   • Use separate syringes at different anatomical sites 1

2. DTaP Series Schedule:

   • First dose: Immediate (with TIG)
   • Second dose: 4 weeks after first dose
   • Third dose: 6-12 months after second dose 1

3. Follow-up Care:

   • Ensure wound cleaning and appropriate wound care
   • Establish a recall system to complete the full vaccination series
   • Consider antibiotic prophylaxis if wound is heavily contaminated 2

Important Considerations

• The CDC guidelines specifically state that persons with unknown or uncertain tetanus vaccination histories should be considered to have had no previous tetanus toxoid-containing vaccine 1

• For children <7 years with no prior tetanus vaccination and contaminated wounds, both TIG and DTaP are required 1, 3

• Failure to provide both passive (TIG) and active (DTaP) immunization could result in tetanus infection, which has a high mortality rate of approximately 25% 2

• The patient will need to complete the full DTaP series to ensure long-term protection against tetanus, diphtheria, and pertussis 1