Does a scorpion sting require a tetanus (Td) shot?

Tetanus Prophylaxis for Scorpion Stings

Scorpion stings do NOT routinely require tetanus vaccination unless the wound is contaminated or the patient's tetanus immunization status is inadequate.

Wound Classification and Tetanus Risk

The 2024 American Heart Association and American Red Cross guidelines for first aid do not classify scorpion stings as requiring routine tetanus prophylaxis 1. Scorpion stings cause envenomation through injection of venom, not through contamination with tetanus spores 1. The primary treatment focuses on localized wound care and pain management, not tetanus prevention 1.

When Tetanus Vaccination IS Indicated

Tetanus prophylaxis should be considered only if:

• An open wound develops at the sting site that becomes contaminated with dirt, soil, or other environmental material 1
• The patient has an incomplete primary vaccination series (<3 doses) or unknown tetanus immunization history 1, 2
• The patient's last tetanus booster was ≥10 years ago for a clean wound, or ≥5 years ago if the wound becomes contaminated 1, 2

Vaccination Algorithm When Indicated

For patients with ≥3 previous tetanus doses:

• If last dose was <5 years ago: No tetanus vaccine needed 1, 2
• If last dose was ≥5 years ago (contaminated wound): Administer Tdap (if never received Tdap) or Td (if previously received Tdap) WITHOUT tetanus immune globulin (TIG) 1, 2
• If last dose was ≥10 years ago (clean wound): Administer Tdap or Td 1

For patients with <3 doses or unknown history:

• Administer BOTH tetanus toxoid-containing vaccine AND TIG (250 units IM at separate site) 1, 2
• Complete the 3-dose primary series subsequently 1, 2

Special Populations

• Pregnant women: Use Tdap regardless of prior Tdap history if tetanus vaccination is indicated 1, 2
• Immunocompromised patients (including HIV): Receive TIG regardless of tetanus immunization history if wound is contaminated 1, 2
• History of Arthus reaction: Do not administer tetanus vaccine until >10 years after most recent dose, regardless of wound severity 1, 2

Critical Clinical Pearls

The key distinction is that scorpion stings themselves are venomous injuries, not tetanus-prone wounds 1. Tetanus prophylaxis follows standard wound management protocols only if secondary wound contamination occurs 1. Most scorpion stings cause only localized pain and swelling without breaking the skin barrier significantly 1, 3.

Common pitfall: Do not confuse the need for wound care and pain management (which IS indicated for all scorpion stings) with the need for tetanus prophylaxis (which is NOT routinely indicated) 1. The 2024 AHA/ARC guidelines explicitly recommend over-the-counter analgesics, topical lidocaine, and ice for scorpion stings, with no mention of routine tetanus vaccination 1.