From the Guidelines
Tetanus immunoglobulin (TIG) is indicated for individuals with wounds who have not completed a primary tetanus vaccination series or whose vaccination status is unknown, especially for contaminated, deep, or puncture wounds, as recommended by the most recent guidelines 1.
Indications for TIG
The following individuals should receive TIG:
- Those with wounds who have not completed a primary tetanus vaccination series
- Those whose vaccination status is unknown
- Those with tetanus-prone wounds, including:
- Wounds contaminated with dirt, feces, soil, or saliva
- Puncture wounds
- Avulsions
- Wounds from crushing, burns, or frostbite
- Wounds with devitalized tissue
Dosage and Administration
- The standard dose of TIG is 250 units intramuscularly for routine prophylaxis, as recommended by the CDC 1
- TIG should be administered at a different site from the tetanus toxoid vaccine, which should be given concurrently to begin developing active immunity
- For established tetanus infection, 3,000-6,000 units of TIG may be recommended
Importance of TIG
TIG provides immediate passive immunity against tetanus toxin by neutralizing circulating toxin before it can bind to nerve endings. It is particularly important for immunocompromised patients who may not respond adequately to vaccination alone. The protection from TIG lasts approximately 3-4 weeks, during which time active immunity can develop from vaccination 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 immunoglobulin 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
Indications for Tetanus Immunoglobulin
- Tetanus immunoglobulin should be reserved for patients with wounds who had never received primary immunization against tetanus 3.
- The use of tetanus immunoglobulin is recommended for individuals who have not been previously immunized against tetanus, as it provides immediate protection against the toxin 4.
- Tetanus immunoglobulin is used to provide passive immunity to individuals who are at risk of tetanus infection, particularly those with wounds or injuries that may be contaminated with tetanus spores 3, 4.
- The administration of tetanus antitoxin, including tetanus immunoglobulin, is an important part of the treatment of tetanus, particularly in settings where access to mechanical ventilation and intensive care facilities is limited 5.
Key Considerations
- The decision to administer tetanus immunoglobulin should be based on the individual's immunization history and the risk of tetanus infection 3.
- Tetanus immunoglobulin is not a substitute for active immunization with tetanus toxoid, and individuals who receive tetanus immunoglobulin should still be immunized with tetanus toxoid as soon as possible 4.
- The use of tetanus immunoglobulin should be guided by clinical judgment and should take into account the individual's overall health status and the risk of adverse reactions 3, 5.