Tetanus Prophylaxis After Dog Bite
Yes, you need a tetanus shot (Td or Tdap) after a dog bite if your last tetanus vaccination was more than 5 years ago. 1
Wound Classification and Tetanus Risk
- Dog bites are classified as "non-clean wounds" that may be contaminated with dirt, feces, soil, or saliva 1
- These wounds carry a significant risk of tetanus infection due to potential contamination 1, 2
Tetanus Prophylaxis Guidelines Based on Immunization Status
For Non-Clean Wounds (including dog bites):
- If your last tetanus toxoid-containing vaccine was less than 5 years ago: No tetanus toxoid-containing vaccine or TIG (Tetanus Immune Globulin) is needed 1
- If your last tetanus toxoid-containing vaccine was 5 years ago or longer: Tetanus toxoid-containing vaccine should be administered without TIG 1
- For persons aged 11 years or older who have never received Tdap or have unknown Tdap history, Tdap is preferred over Td 1
- For persons with documented previous Tdap, either Td or Tdap may be used 1
Initial Wound Management
- Immediate and thorough washing of all bite wounds with soap and water is crucial for preventing infection and reducing the risk of tetanus 3, 4
- Gentle irrigation with water or a dilute povidone-iodine solution markedly decreases the risk of bacterial infection 4, 5
- The wound should be explored for tendon or bone involvement and possible foreign bodies 5
Special Considerations
- Pregnant women requiring tetanus prophylaxis should receive Tdap regardless of prior Tdap history 1
- Persons with HIV infection or severe immunodeficiency who have contaminated wounds should receive TIG regardless of their tetanus immunization history 1
- Persons with a history of an Arthus reaction following a previous tetanus toxoid-containing vaccine should not receive a tetanus toxoid-containing vaccine until more than 10 years after the most recent dose, regardless of wound condition 1
Additional Management Considerations
- Antibiotic prophylaxis should be considered, especially with high-risk wounds; amoxicillin/clavulanate is the first-line choice 6, 5, 7
- The need for rabies prophylaxis should be assessed based on the vaccination status of the dog and the circumstances of the bite 3
- For rabies exposure, previously unvaccinated persons should receive both rabies immune globulin and vaccine 4
Common Pitfalls to Avoid
- Do not assume dog bites are "clean wounds" - they should always be treated as contaminated wounds requiring appropriate tetanus prophylaxis 1
- Do not delay wound cleaning and irrigation, as immediate thorough cleansing significantly reduces infection risk 4, 8
- When both TIG and tetanus toxoid-containing vaccine are indicated, they should be administered using separate syringes at different anatomical sites 1