How soon should tetanus vaccine be administered after a wound?

Tetanus Prophylaxis Timing After Wound Injury

For tetanus prophylaxis, tetanus toxoid-containing vaccine should be administered as soon as possible after wound injury if indicated, ideally within 24 hours, but it remains effective even when given several days after injury. 1, 2

Tetanus Prophylaxis Decision Algorithm

The need for tetanus prophylaxis depends on:

1. Wound characteristics
2. Patient's vaccination history

Wound Assessment

• Clean, minor wounds: Less risk for tetanus
• Other wounds (contaminated, puncture wounds, avulsions, wounds from crushing, burns, frostbite): Higher risk 2

Vaccination History Assessment

For patients with complete primary vaccination series:

• Last dose <5 years ago: No tetanus toxoid-containing vaccine needed
• Last dose 5-10 years ago:
  • For clean, minor wounds: No tetanus toxoid-containing vaccine needed
  • For all other wounds: Tetanus toxoid-containing vaccine recommended
• Last dose >10 years ago: Tetanus toxoid-containing vaccine recommended regardless of wound type 1

For patients with unknown/incomplete vaccination history:

• For all wounds: Begin/complete primary vaccination series
• For wounds other than clean, minor wounds: Add Tetanus Immune Globulin (TIG) 250 units IM 1, 2

Vaccine Selection

• For adults ≥11 years who have not previously received Tdap: Tdap is preferred over Td 1
• For adults who previously received Tdap: Use Td for subsequent doses 1

Important Clinical Considerations

• When both TIG and tetanus toxoid-containing vaccine are indicated, administer using separate syringes at different anatomical sites 1, 2
• Immediate and thorough wound cleaning is critical for tetanus prevention 2
• The tetanus toxoid-containing vaccine provides protection against future injuries, not the current wound 3
• TIG provides immediate passive immunity for the current wound 2

Special Populations

• Immunocompromised patients: Should receive TIG regardless of vaccination history if they have contaminated wounds 2
• Pregnant women: Should receive Tdap if tetanus prophylaxis is indicated 2

Common Pitfalls to Avoid

1. Delaying tetanus prophylaxis: While the vaccine is most effective when given promptly, it should not be withheld even if several days have passed since injury 4

2. Overuse of TIG: Reserve TIG for patients with unknown/incomplete vaccination histories with contaminated wounds 1, 2

3. Underestimating "minor" wounds: Tetanus can occur after seemingly innocuous injuries 3

4. Forgetting to complete the primary series: For patients receiving their first or second dose, ensure they complete the full three-dose series 1

5. Arthus reaction concerns: For patients with history of Arthus reaction after previous tetanus toxoid-containing vaccine, wait >10 years before administering another dose 1

The evidence consistently supports prompt administration of tetanus prophylaxis following injury when indicated based on wound characteristics and vaccination history, with the goal of preventing this potentially fatal disease that still carries a 25% case-fatality rate 2.