How long is tetanus vaccination recommended after a cat bite?

Tetanus Vaccination After Cat Bite

For cat bites, tetanus prophylaxis should be administered if it has been 5 or more years since the last tetanus toxoid-containing vaccine dose, as cat bites are classified as contaminated wounds. 1, 2

Tetanus Prophylaxis Guidelines Based on Vaccination Status

For Fully Immunized Individuals (≥3 doses of tetanus vaccine)

• If last tetanus vaccination was <5 years ago: No tetanus toxoid-containing vaccine or tetanus immune globulin (TIG) needed 1, 2
• If last tetanus vaccination was ≥5 years ago: Administer tetanus toxoid-containing vaccine without TIG 1
• If last tetanus vaccination was ≥10 years ago: Administer tetanus toxoid-containing vaccine as part of routine booster schedule 1

For Individuals with Unknown or Incomplete Vaccination History (<3 doses)

• Administer tetanus toxoid-containing vaccine AND tetanus immune globulin (TIG) immediately, using separate syringes at different anatomical sites 1, 3
• Begin or complete a primary vaccination series (3 doses total) 1
• First two doses should be administered at least 4 weeks apart 1
• Third dose should be given 6-12 months after the second dose 1

Vaccine Selection Guidelines

• For persons aged ≥11 years who have not previously received Tdap or have unknown Tdap history: Tdap is preferred over Td 1
• For persons with documented previous Tdap vaccination: Either Td or Tdap may be used 1
• For pregnant women: Tdap should be used regardless of prior Tdap history 1
• For children aged <7 years: DTaP is recommended 1
• For children aged 7-10 years: Tdap is preferred 1

Special Considerations

• Persons with HIV infection or severe immunodeficiency who have contaminated wounds should receive TIG regardless of their tetanus immunization history 1, 2
• Cat bites should always be classified as "non-clean wounds" that may be contaminated with dirt, feces, soil, and saliva 2, 4
• When both TIG and tetanus toxoid-containing vaccine are indicated, administer using separate syringes at different anatomical sites 1, 3
• Persons with a history of an Arthus reaction following a previous 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

Clinical Pearls and Pitfalls

• Do not assume cat bites are "clean wounds" - cats are coprophagic animals which increases the potential risk of tetanus transmission 2
• Proper wound care and debridement play a critical role in tetanus prevention in addition to vaccination 1
• Even with a history of complete vaccination, tetanus cases have been reported after animal bites, though they are typically milder in previously immunized patients 5
• The standard dose of tetanus immune globulin for prophylaxis is 250 units administered intramuscularly 3
• Tetanus toxoid-containing vaccines provide long-lasting protection, with boosters needed every 10 years for general protection and every 5 years for contaminated wound management 1, 6