From the Guidelines
Tetanus immune globulin (TIG) is indicated for individuals with wounds who have not completed a primary tetanus vaccination series, whose vaccination status is unknown, or have contaminated wounds, especially those with dirt, feces, soil, or saliva; puncture wounds; avulsions; and wounds resulting from missiles, crushing, burns, and frostbite, as outlined in the guide to tetanus prophylaxis in routine wound management 1.
Key Indications for TIG
- Unknown or less than 3 doses of adsorbed tetanus toxoid–containing vaccines
- Contaminated wounds, such as those with dirt, feces, soil, or saliva; puncture wounds; avulsions; and wounds resulting from missiles, crushing, burns, and frostbite
- Persons with HIV infection or severe immunodeficiency who have contaminated wounds, regardless of their history of tetanus immunization 1
Administration of TIG
- Should be administered as soon as possible after injury, ideally within 24 hours
- Dose of 250-500 units intramuscularly for most adults and children
- For more extensive wounds or delayed treatment, higher doses may be needed
- Should be given at a different site from tetanus toxoid (Td/Tdap) when both are indicated 1
Importance of Concurrent Active Immunization
- While TIG provides immediate protection, it only lasts 3-4 weeks
- Concurrent active immunization with tetanus toxoid should be initiated to provide long-term protection
- DTaP is recommended for children aged <7 years, and Tdap is preferred to Td for persons aged ≥11 years who have not previously received Tdap 1
From the FDA Drug Label
HyperTET is indicated for prophylaxis against tetanus following injury in patients whose immunization is incomplete or uncertain. It is also indicated, although evidence of effectiveness is limited, in the regimen of treatment of active cases of tetanus. The indications for tetanus immune globulin are:
- Prophylaxis against tetanus following injury in patients with incomplete or uncertain immunization
- Treatment of active cases of tetanus, although evidence of effectiveness is limited 2
From the Research
Tetanus Immune Globulin Indications
- Tetanus immune globulin (TIG) is used for post-exposure prophylaxis of tetanus in individuals with tetanus-prone wounds 3, 4
- TIG is administered simultaneously with a tetanus-diphtheria vaccine to provide immediate protection against tetanus 3, 5
- The use of TIG is recommended for individuals who have not been immunized against tetanus or whose immunity has waned, particularly the elderly 4, 6
- TIG can be used in conjunction with tetanus toxoid to provide both immediate and long-term protection against tetanus 7
- The administration of TIG is also recommended for individuals with tetanus-prone wounds who have a history of inadequate immunization or lack seroprotection 6
Patient Groups Requiring Tetanus Immune Globulin
- Individuals with tetanus-prone wounds, such as those with deep or dirty wounds 3, 4
- The elderly, who are at greater risk of tetanus due to waning immunity 4, 6
- Immigrants from outside North America or Western Europe, who may have inadequate immunization histories 6
- Individuals with a history of inadequate immunization or lack of seroprotection 6
- Persons without education beyond grade school, who may be at higher risk of tetanus due to limited access to healthcare 6