For a patient with a recent tetanus toxoid shot and a category II dog bite, should a tetanus toxoid booster be administered and what is the recommended regimen?

Tetanus Vaccination for Category II Dog Bite with Recent Tetanus Toxoid

Yes, administer a tetanus toxoid-containing vaccine (Tdap preferred) immediately if ≥5 years have elapsed since the last dose; no tetanus immune globulin (TIG) is needed for patients with a complete primary vaccination series. 1, 2

Wound Classification

• Category II dog bites (involving skin contact with minor scratches or abrasions without bleeding) are classified as contaminated, tetanus-prone wounds because animal bites may be contaminated with dirt, feces, soil, and saliva, which determines a critical 5-year interval for booster administration rather than the routine 10-year interval. 1, 2

Vaccination Algorithm Based on Time Since Last Dose

If last tetanus dose was <5 years ago:

• No tetanus toxoid-containing vaccine or TIG is needed, as the patient remains protected against tetanus. 1, 2
• Persons who completed the primary series and received tetanus toxoid <5 years earlier are protected and do not require additional vaccination as part of wound management. 1

If last tetanus dose was ≥5 years ago:

• Administer tetanus toxoid-containing vaccine immediately WITHOUT TIG. 1, 2, 3
• Tdap is strongly preferred over Td if the patient has not previously received Tdap or Tdap history is unknown, as this provides additional protection against pertussis. 1, 2, 4
• For nonpregnant persons with documented previous Tdap vaccination, either Td or Tdap may be used. 1, 4

If vaccination history is unknown or <3 lifetime doses:

• Administer BOTH tetanus toxoid-containing vaccine (Tdap preferred) AND TIG 250 units IM at separate anatomic sites using separate syringes. 1, 2, 3
• Complete the 3-dose primary vaccination series at recommended intervals. 1, 2

Specific Regimen for Your Patient

Since you mentioned the patient had a tetanus toxoid shot on [DATE], calculate the time elapsed:

• If [DATE] was <5 years ago: No tetanus vaccination needed for this dog bite. 1, 2
• If [DATE] was ≥5 years ago: Give Tdap (or Td if prior Tdap documented) as a single 0.5 mL intramuscular injection in the deltoid muscle. 1, 3

Special Populations Requiring TIG Despite Complete Vaccination

• Severely immunocompromised patients (HIV infection, severe immunodeficiency) with contaminated wounds should receive TIG regardless of tetanus immunization history. 1, 2, 4
• Pregnant women requiring tetanus toxoid should receive Tdap regardless of prior Tdap history. 1, 4

Critical Clinical Pearls

• Do not confuse the 10-year routine booster interval with the 5-year interval for contaminated wounds—this is the most common error in tetanus prophylaxis. 2, 5
• More frequent doses than recommended may be associated with increased incidence and severity of adverse reactions, including Arthus-type hypersensitivity reactions. 1, 3
• Patients with a history of Arthus reaction should not receive tetanus toxoid-containing vaccine until >10 years after the most recent dose, regardless of wound severity. 1, 2, 3
• There is no urgency for tetanus toxoid administration in the acute setting, as it provides protection against the next injury rather than the current injury—persons with at least two prior doses rapidly develop antitoxin antibodies after a booster. 4, 6, 7
• Proper wound cleaning and debridement are critical components of tetanus prevention in addition to vaccination. 1, 2, 5

Rabies Vaccination Considerations

• Rabies post-exposure prophylaxis and tetanus prophylaxis are independent decisions and can be administered concurrently at different anatomic sites. 8
• The rabies vaccination regimen follows WHO recommendations and does not interfere with tetanus toxoid administration. 8