Tetanus Prophylaxis for Infected Rusted Nail Injury with Vaccination 1 Year Ago
A person vaccinated 1 year ago with a rusted nail injury requires ONE dose of tetanus toxoid-containing vaccine (Tdap preferred if not previously received, otherwise Td), with NO tetanus immune globulin needed. 1, 2
Wound Classification
- Rusted nail puncture wounds are classified as contaminated/tetanus-prone wounds because puncture injuries may be contaminated with dirt, soil, and other debris, which determines a critical 5-year interval (rather than 10-year) for booster administration 1
Vaccination Algorithm for This Scenario
Since the patient was vaccinated 1 year ago (which is <5 years), the standard recommendation would be NO vaccine needed. However, the question states this is an infected wound, which warrants clinical judgment:
For Contaminated Wounds with ≥3 Previous Doses:
- If last dose was <5 years ago: No tetanus toxoid-containing vaccine or TIG is needed 1, 2
- If last dose was ≥5 years ago: Administer ONE dose of tetanus toxoid-containing vaccine WITHOUT TIG 3, 1
Critical Decision Point:
Since vaccination occurred only 1 year ago and assuming completion of primary series (≥3 doses), NO additional tetanus vaccination is required, even for this contaminated wound. 2 The CDC explicitly states that adults who received a tetanus toxoid-containing vaccine <5 years earlier are protected against tetanus and do not require additional vaccination as part of wound management 3, 2
Vaccine Selection if Dose Were Indicated
- Tdap is preferred over Td for persons ≥11 years who have not previously received Tdap or whose Tdap history is unknown 3, 1
- For nonpregnant persons with documented previous Tdap vaccination, either Td or Tdap may be used 3, 1
- If the patient is pregnant, Tdap should be used regardless of prior Tdap history 3, 1
When TIG Would Be Required
TIG (250 units IM) is indicated ONLY when: 1, 4
- Patient has <3 previous doses OR unknown vaccination history
- Patient is severely immunocompromised (HIV infection, severe immunodeficiency) regardless of vaccination timing 1, 2, 5
Critical Clinical Pitfalls
- Do NOT give unnecessary boosters: More frequent doses than recommended may be associated with increased incidence and severity of adverse reactions, including Arthus-type hypersensitivity reactions 3, 4
- Patients with prior Arthus reactions should not receive tetanus toxoid until >10 years after the most recent dose, even for contaminated wounds 3, 1, 5
- Immunologic memory is robust: Persons who received at least 2 doses develop rapid antitoxin response upon re-exposure, providing protection even before a booster would take effect 6
Answer Summary
For this specific case (vaccinated 1 year ago, infected rusted nail): ZERO doses of tetanus toxoid are needed if the patient completed their primary series (≥3 lifetime doses). 1, 2 The 1-year interval is well within the 5-year protective window for contaminated wounds.