What tetanus prophylaxis is recommended for a 21-year-old male with a superficial stab wound and a last tetanus booster shot at age 15?

Tetanus Prophylaxis for Stab Wound with Recent Tetanus Booster

For a 21-year-old male with a superficial stab wound to the left shoulder who received his last tetanus booster 6 years ago, no tetanus prophylaxis is needed as his last booster was within the recommended 10-year interval for clean, minor wounds.

Assessment of Wound and Immunization Status

• The patient has a superficial stab wound to the left shoulder, which is classified as a clean, minor wound if not heavily contaminated with dirt or feces 1, 2
• The patient has a complete primary vaccination series (received full series as a child) and received a booster 6 years ago at age 15 1
• For clean, minor wounds, a tetanus booster is only recommended if the patient has not received a dose within the last 10 years 1, 3

Recommended Prophylaxis Based on Guidelines

• According to CDC guidelines, for patients with complete primary vaccination series who sustained clean, minor wounds, no tetanus toxoid or TIG is needed if the last booster was received within the past 10 years 1, 3
• The patient's last booster was 6 years ago, which falls within the 10-year window for clean, minor wounds 1, 2
• For non-clean wounds (contaminated with dirt, feces, etc.), a booster would be appropriate if the patient had not received tetanus toxoid during the preceding 5 years 1

Tetanus Prophylaxis Decision Algorithm

1. Assess wound type:

   • Clean, minor wound: Booster needed only if >10 years since last dose 1, 3
   • Non-clean wound: Booster needed if >5 years since last dose 1

2. Assess immunization status:

   • Complete primary series (≥3 doses): Follow above timing guidelines 1, 3
   • Incomplete or unknown status (<3 doses): Would require both tetanus toxoid and TIG 1, 2

3. In this case:

   • Clean, minor wound + complete primary series + last booster 6 years ago = No prophylaxis needed 1, 3

Common Pitfalls to Avoid

• Unnecessary administration of tetanus toxoid when not indicated can lead to increased risk of local reactions and Arthus-type hypersensitivity reactions, especially in patients who have received multiple boosters 1
• Failing to distinguish between clean, minor wounds (10-year interval) and non-clean wounds (5-year interval) when determining need for booster 1, 2
• Administering TIG when not indicated - TIG is only needed for patients with incomplete or unknown vaccination history 1, 2

Special Considerations

• If the wound were heavily contaminated (tetanus-prone), a booster would be indicated since the last dose was >5 years ago 1
• For patients with immunocompromising conditions, additional considerations may apply, but this is not mentioned in the patient's history 2