Should someone with a recent cut receive a tetanus (Td or Tdap) shot?

Tetanus Vaccination After a Recent Cut

Whether someone with a recent cut needs a tetanus shot depends on two critical factors: their vaccination history and the type of wound—if they received their last tetanus vaccine less than 5 years ago and have completed their primary series, no vaccine is needed regardless of wound type. 1, 2

Vaccination Decision Algorithm

Step 1: Determine Vaccination History

For patients with documented complete primary series (≥3 doses):

• Clean, minor wounds: No tetanus vaccine needed if last dose was within 10 years 2
• All other wounds (tetanus-prone): No tetanus vaccine needed if last dose was within 5 years 1, 2
• Tetanus-prone wounds include: those contaminated with dirt, feces, soil, saliva; puncture wounds; avulsions; wounds from missiles, crushing, burns, and frostbite 3, 2

For patients with unknown or incomplete vaccination history (<3 doses):

• Any wound: Administer tetanus vaccine immediately 1, 2
• Tetanus-prone wounds: Administer BOTH tetanus vaccine AND tetanus immune globulin (TIG) 250 units 3, 2

Step 2: Select the Appropriate Vaccine

For persons aged ≥11 years who have never received Tdap:

• Tdap is strongly preferred over Td to provide pertussis protection 4, 1
• This applies even if the patient needs tetanus prophylaxis before the typical 10-year interval 4

For persons who previously received Tdap:

• Use Td for subsequent tetanus boosters 1

Step 3: Administer TIG When Indicated

TIG is required for tetanus-prone wounds when:

• Vaccination history is unknown or incomplete (<3 doses) 3, 2
• Patient has HIV infection or severe immunodeficiency (regardless of vaccination history) 1, 3

Critical administration detail: When both TIG and tetanus vaccine are given, use separate syringes at different anatomic sites 4, 3, 2

Common Pitfalls to Avoid

The most critical error is over-vaccination: A 2021 study found that 22.1% of patients received unnecessary tetanus vaccines within 5 years of their previous dose, and clinical decision support reduced this by 36.7% 5. More frequent boosters are not needed and can accentuate side effects 2.

The second major pitfall is under-vaccination of high-risk wounds: A 2024 case report documented generalized tetanus in a properly vaccinated patient whose last booster was 7 years prior to a high-risk agricultural injury—she should have received prophylaxis since >5 years had elapsed 6. This demonstrates that the 5-year rule for tetanus-prone wounds must be strictly followed.

Treating unknown vaccination history as "probably vaccinated": Patients with unknown or uncertain histories must be considered to have had no previous tetanus toxoid-containing vaccine 4, 2. This is non-negotiable, even for patients with military service since 1941 (who likely received at least one dose but may not have completed the series) 2.

Special Considerations

Arthus reaction history: Patients with a history of Arthus reaction after previous tetanus vaccination should not receive tetanus vaccine until >10 years after the most recent dose, even with a tetanus-prone wound 4, 1, 3. In this situation, the decision to administer TIG is based solely on primary vaccination history 4.

Incomplete primary series: Patients who never completed the 3-dose primary series need the full series initiated: Tdap first dose, followed by Td at >4 weeks, then Td at 6-12 months 1, 2.

Timing is not urgent for the current wound: Tetanus toxoid provides protection against the next injury, not the current one, as it takes time to develop immunity 7. However, it should still be administered during the wound visit to ensure future protection.