From the Guidelines
For tetanus prophylaxis after an injury, either Tdap or Td vaccines can be used, and a booster is recommended if it's been more than 10 years since your last tetanus-containing vaccine for clean, minor wounds, or more than 5 years for dirty wounds, as indicated by the Advisory Committee on Immunization Practices (ACIP) in 2019 1. When considering tetanus prophylaxis, it's crucial to assess the type of wound and the time elapsed since the last tetanus vaccination.
- For clean, minor wounds, a Tdap booster is recommended if the last tetanus-containing vaccine was more than 10 years ago.
- For dirty wounds (contaminated with dirt, feces, soil, or saliva; puncture wounds; avulsions; or wounds from crushing, burns, or frostbite), a booster is recommended if it's been more than 5 years since the last tetanus vaccination. The use of Tdap is preferable due to its protection against tetanus, diphtheria, and pertussis, as opposed to the older Td vaccine which only protects against tetanus and diphtheria 1. In cases where the patient has never been vaccinated against tetanus or has an uncertain history, tetanus immune globulin (TIG) should also be administered at a dose of 250-500 units intramuscularly for dirty wounds, in addition to beginning the primary vaccination series. Tetanus is a serious condition caused by the bacterium Clostridium tetani, which can lead to painful muscle contractions and be fatal if left untreated, emphasizing the importance of prompt prophylaxis after injury 1.
From the Research
Tetanus Booster with Injury and Tdap
- The use of Tdap vaccine in wound management is recommended by the Advisory Committee on Immunization Practices (ACIP) for adolescents and adults who require a tetanus toxoid-containing vaccine and have not previously received Tdap 2.
- A study published in JAMA found that a single dose of Tdap vaccine elicited robust immune responses in adolescents and adults to pertussis, tetanus, and diphtheria antigens, with an overall safety profile similar to that of a licensed Td vaccine 3.
- The impact of Tdap vaccine use in wound management on health care costs and pertussis cases was estimated using a decision-analytic economic model, which found that vaccination with Tdap instead of Td was estimated to cost an additional $0.01 to $0.03 per member per month (PMPM) for health plans 2.
- Guidelines for vaccine prophylaxis and other preventive measures for diphtheria, tetanus, and pertussis have been updated by the Immunization Practices Advisory Committee (ACIP) to include revisions in the schedule for combined diphtheria and tetanus toxoids, and recommendations on precautions and contraindications to vaccine use 4.
- A study published in Birth Defects Research found no evidence of appreciable risks for selected specific major malformations associated with Tdap vaccine exposure during early or late pregnancy, providing further reassurance regarding the current recommendations for Tdap vaccination in pregnancy 5.
Key Findings
- Tdap vaccine is recommended for use in wound management for adolescents and adults who require a tetanus toxoid-containing vaccine and have not previously received Tdap 2.
- Tdap vaccine elicits robust immune responses in adolescents and adults to pertussis, tetanus, and diphtheria antigens 3.
- The use of Tdap vaccine in wound management is estimated to cost an additional $0.01 to $0.03 PMPM for health plans 2.
- Tdap vaccine exposure during pregnancy is not associated with an increased risk of major birth defects 5.