Is tetanus prophylaxis (tetanus prevention) necessary after a scratch from a stray cat?

From the Guidelines

A tetanus shot is not immediately necessary for a stray cat scratch unless the wound is contaminated or the individual has not had a tetanus booster in the last 10 years, as indicated in the guidelines for tetanus prophylaxis in routine wound management 1. When considering tetanus prophylaxis for a stray cat scratch, it's essential to assess the wound type and the individual's vaccination history. According to the guidelines, for individuals with a history of at least 3 doses of adsorbed tetanus toxoid–containing vaccines, tetanus prophylaxis is not required for clean and minor wounds, but may be necessary for all other wounds, such as those contaminated with dirt, feces, or saliva 1. Key factors to consider include:

• The type of wound: clean and minor versus contaminated or complex
• The individual's vaccination history: number of doses of tetanus toxoid–containing vaccines and time since last dose
• The presence of contamination: dirt, feces, soil, or saliva In general, for individuals with a complete primary tetanus vaccination series, a booster is recommended if the last tetanus toxoid–containing vaccine dose was more than 10 years ago for clean and minor wounds, or more than 5 years ago for all other wounds 1. It's also crucial to clean the wound thoroughly with soap and water, apply an antiseptic, and monitor for signs of infection, as cat scratches can lead to other infections such as cat scratch disease 1.

From the FDA Drug Label

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 Tetanus Immune Globulin (TIG) (Human) depends on both the condition of the wound and the patient's vaccination history (Table 1). TABLE 1 GUIDE TO TETANUS PROPHYLAXIS IN ROUTINE WOUND MANAGEMENT IN PERSONS AGED 7 YEARS AND OLDER

• Such as, but not limited to, wounds contaminated with dirt, feces, soil, and saliva; puncture wounds; avulsions; and wounds resulting from missiles, crushing, burns and frostbite. The answer to whether a tetanus shot is needed for a stray cat scratch depends on the condition of the wound and the patient's vaccination history.

• If the wound is clean and minor, and the patient has had three or more doses of tetanus toxoid, then a tetanus shot is not needed.
• If the wound is not clean and minor (e.g. contaminated with dirt, feces, or saliva), or if the patient's vaccination history is unknown or incomplete, then a tetanus shot may be needed. It is recommended to consult the Advisory Committee on Immunization Practices (ACIP) guidelines for specific recommendations on tetanus prophylaxis in wound management 2.

From the Research

Tetanus Risk from Stray Cat Scratch

• There is no direct mention of tetanus risk from a stray cat scratch in the provided study 3.
• The study focuses on Cat Scratch Disease (CSD) caused by Bartonella henselae bacteria, which can be transmitted through cat scratches.
• It discusses the importance of flea control and testing and treating infected animals to minimize transmission risk.
• The study does not address the specific question of whether a tetanus shot is necessary after a stray cat scratch.
• Therefore, based on the provided evidence, there is no information available to determine if a tetanus shot is required after a stray cat scratch 3.