Tetanus Prophylaxis After Dog Bite for Patient with Recent Tdap Vaccination
A patient who received a Tdap shot in 2022 and recently sustained a dog bite does not require another tetanus booster at this time. 1
Assessment of Need for Tetanus Prophylaxis
- Dog bites are classified as "non-clean wounds" that may be contaminated with dirt, saliva, or other materials, requiring appropriate tetanus prophylaxis assessment 1
- For non-clean wounds like dog bites, tetanus prophylaxis is recommended if the last tetanus toxoid-containing vaccine was administered ≥5 years ago 1, 2
- Since this patient received a Tdap shot in 2022 (less than 5 years ago), no additional tetanus prophylaxis is needed for this dog bite 1, 3
Tetanus Prophylaxis Guidelines Based on Vaccination Status
- For patients with complete vaccination history who received their last tetanus toxoid-containing vaccine within the past 5 years, no additional tetanus prophylaxis is required for contaminated wounds 1, 2
- The Advisory Committee on Immunization Practices (ACIP) recommends tetanus toxoid-containing vaccines only when ≥5 years have elapsed since the last dose for non-clean wounds 3, 1
- More frequent administration of tetanus toxoid-containing vaccines than recommended may be associated with increased incidence and severity of adverse reactions 2
Special Considerations
- Persons who experienced an Arthus-type hypersensitivity reaction following a prior dose of a tetanus toxoid-containing vaccine should not receive tetanus toxoid more frequently than every 10 years, even for wound management 3, 2
- For immunocompromised patients with contaminated wounds, tetanus immune globulin (TIG) may be considered regardless of immunization history, but this does not apply to immunocompetent individuals with recent vaccination 1, 2
Future Tetanus Prophylaxis
- After receiving Tdap, subsequent booster doses of tetanus toxoid-containing vaccine (Td) should be administered every 10 years throughout life 4
- The patient should receive their next tetanus-containing vaccine (Td) in 2032, which would be 10 years after their last Tdap booster 4
- Tdap is licensed for single-dose administration and is not recommended for routine repeat administration; subsequent boosters should be with Td 4
Common Pitfalls to Avoid
- Administering tetanus toxoid too frequently (less than indicated intervals) can increase the risk of adverse reactions, including Arthus-type hypersensitivity reactions 2
- There is a common misconception that tetanus prophylaxis must be administered immediately after every wound; however, if the patient has received appropriate vaccination within the recommended timeframe, additional doses are unnecessary 1, 5
- Tetanus toxoid in the acute setting provides protection against future injuries, not the current injury; protection against the current injury comes from previously established immunity 5