Tetanus Toxoid (TT) Administration Guidelines
Tetanus toxoid-containing vaccines should be administered for wound management when >5 years have passed since the last tetanus toxoid-containing vaccine dose for tetanus-prone wounds, and >10 years for clean, minor wounds. 1
Routine Tetanus Vaccination
- All persons aged 11-18 years should receive a single dose of Tdap (Tetanus, diphtheria, and acellular pertussis), preferably at age 11-12 years 1
- Adults aged ≥19 years who have never received Tdap should receive 1 dose of Tdap, regardless of interval since their last tetanus or diphtheria toxoid-containing vaccine 1
- To ensure continued protection against tetanus and diphtheria, booster doses of either Td or Tdap should be administered every 10 years throughout life 1
- Pregnant women should receive 1 dose of Tdap during each pregnancy at 27-36 weeks' gestation, regardless of prior vaccination history 1
Tetanus Prophylaxis for Wound Management
Clean, Minor Wounds
- If ≥10 years since last tetanus toxoid-containing vaccine: administer tetanus toxoid-containing vaccine 1, 2
- If <10 years since last tetanus toxoid-containing vaccine: no tetanus toxoid-containing vaccine needed 1, 2
- Tetanus Immune Globulin (TIG) is not indicated regardless of vaccination history 2
Tetanus-Prone Wounds
Tetanus-prone wounds include:
- Wounds contaminated with dirt, feces, soil, or saliva
- Puncture wounds
- Avulsions
- Wounds from missiles, crushing, burns, and frostbite 1, 3
Recommendations:
- If ≥5 years since last tetanus toxoid-containing vaccine: administer tetanus toxoid-containing vaccine 1
- For persons aged ≥11 years who have not previously received Tdap or whose Tdap history is unknown, Tdap is preferred over Td 1
- For pregnant women requiring tetanus prophylaxis, Tdap should be used 1
- For non-pregnant persons with documentation of previous Tdap vaccination, either Td or Tdap may be used 1
TIG Administration Guidelines
- Persons with unknown or incomplete tetanus vaccination history (<3 doses) who sustain tetanus-prone wounds should receive both tetanus toxoid-containing vaccine AND TIG (250 units IM) 3, 2
- Persons with HIV infection or severe immunodeficiency who have contaminated wounds should receive TIG regardless of their tetanus immunization history 1, 3
- When both TIG and tetanus toxoid-containing vaccine are indicated, administer using separate syringes at different anatomical sites 1, 3
Special Considerations
Persons with Unknown or Incomplete Vaccination History
- Persons with unknown or uncertain previous tetanus vaccination histories should be considered to have had no previous tetanus toxoid-containing vaccine 1, 2
- Adults who have never been vaccinated against tetanus should receive a series of three vaccinations containing tetanus and diphtheria toxoids 1
- The preferred schedule is 1 dose of Tdap, followed by 1 dose of either Td or Tdap ≥4 weeks afterward, and 1 dose of either Td or Tdap 6-12 months later 1
Contraindications and Precautions
- Persons with a history of Arthus reaction following a previous dose of a tetanus toxoid-containing vaccine should not receive a tetanus toxoid-containing vaccine until >10 years after the most recent dose, regardless of wound condition 1, 3
Clinical Pitfalls to Avoid
- Do not assume that tetanus toxoid alone provides immediate protection against tetanus for the current wound; it protects against future injuries 4, 5
- Do not delay TIG administration in patients with tetanus-prone wounds who have incomplete vaccination history, as severe tetanus can develop despite tetanus toxoid administration 6, 7
- Do not underestimate the importance of wound cleaning and debridement, which are crucial components of tetanus prevention 1, 7
- Remember that the ability to promptly react to a booster injection (immunological memory) is long-lasting in persons who have previously received at least two doses of tetanus toxoid 8
By following these evidence-based guidelines for tetanus prophylaxis, clinicians can effectively prevent this potentially fatal but preventable disease.