Is a Td (tetanus and diphtheria) booster indicated for a patient who received Tdap (tetanus, diphtheria, and pertussis) vaccine in 2016 and now presents with a leg wound from a sharp object in 2025?

From the Guidelines

A Td (tetanus and diphtheria) booster is not needed at this time. Since the patient received a Tdap vaccine in 2016, they are still within the recommended 10-year protection period for tetanus, which extends to 2026 1. The wound from a butter container is considered a clean, minor wound with low risk for tetanus infection. Tetanus boosters are typically recommended every 10 years for routine protection, or earlier only if a person sustains a high-risk wound (such as a deep puncture, contaminated with dirt or manure) and their last tetanus vaccination was more than 5 years ago. In this case, neither condition applies - the wound is low-risk and the previous vaccination is within both the 5-year window for high-risk wounds and the 10-year window for routine boosters. The patient should clean the wound thoroughly with soap and water and monitor for signs of infection, but no additional tetanus prophylaxis is necessary at this time. According to the Advisory Committee on Immunization Practices (ACIP) recommendations, for nonpregnant persons aged ≥7 years who had previously received Tdap, Td has been recommended for tetanus prophylaxis in wound management 1. However, the patient's wound is minor and clean, and their last Tdap vaccination was in 2016, which is within the recommended time frame for both routine and high-risk wound protection 1. Therefore, no Td booster is necessary at this time, and the patient should focus on wound care and monitoring for signs of infection.

From the FDA Drug Label

2.4 Tetanus Prophylaxis in Wound Management

For active tetanus immunization in wound management of patients 7 years of age and older, a preparation containing tetanus and diphtheria toxoids is preferred instead of single-antigen tetanus toxoid to enhance diphtheria protection. The need for active immunization with a tetanus toxoid-containing preparation, with or without passive immunization with Tetanus Immune Globulin (TIG) (Human) depends on both the condition of the wound and the patient's vaccination history. Table 1: Guide for use of Tetanus and Diphtheria Toxoids Adsorbed (Td) for Tetanus Prophylaxis in Routine Wound Management in Persons 7 Years of Age and Older History of Adsorbed Tetanus Toxoid (Doses)Clean, Minor WoundsAll Other Wounds* TdTIGTdTIG

• Such as, but not limited to, wounds contaminated with dirt, puncture wounds and traumatic wounds ‡ Yes, if >10 years since last dose.

The patient received a Tdap vaccine in 2016 and now has a leg wound from a butter container.

• The wound from a butter container can be considered a clean, minor wound.
• The patient's last tetanus toxoid-containing vaccine was more than 5 years but less than 10 years ago (Tdap in 2016). According to the guidelines in Table 1, for a person with a history of ≥ three doses of tetanus toxoid, a Td booster is not needed for clean, minor wounds, but it is needed for all other wounds if it has been more than 10 years since the last dose or more than 5 years since the last dose for dirty or traumatic wounds. Since the wound is clean and minor, and it has been less than 10 years since the last dose, a Td booster is not indicated 2.

From the Research

Tdap Booster Considerations

• The patient received a Tdap vaccine in 2016, and it is now 2025, which is approximately 9 years later.
• The patient has a leg wound from a butter container, which may increase the risk of tetanus infection.
• According to the available studies, there is no direct evidence to support the administration of a Td booster in this specific scenario 3.
• However, it is generally recommended to administer a Td booster every 10 years, or in cases of dirty or tetanus-prone wounds 3.

Shoulder Injury Related to Vaccine Administration (SIRVA)

• The provided studies discuss SIRVA, a recognized complication of intramuscular vaccinations, characterized by shoulder pain and limited range of motion 4, 5, 6, 7.
• SIRVA is not directly relevant to the decision of administering a Td booster in this scenario, as the patient's wound is on the leg, not the shoulder.
• Nevertheless, it is essential to consider proper injection techniques to minimize the risk of SIRVA when administering vaccinations 6, 7.

Wound Management and Tetanus Prophylaxis

• The management of the patient's leg wound and the decision to administer a Td booster should be based on the wound's characteristics, such as its cleanliness and the risk of tetanus infection.
• The available studies do not provide specific guidance on the administration of a Td booster in this scenario, and the decision should be made based on clinical judgment and current vaccination guidelines 3.