From the Guidelines
For a skin laceration with the last DTaP vaccine in 2016, a tetanus booster is not immediately necessary unless the wound is contaminated, as it has been approximately 7 years since the last dose, which is less than the 10-year threshold for clean and minor wounds. According to the guide to tetanus prophylaxis in routine wound management 1, the recommendation for tetanus prophylaxis depends on the number of doses of adsorbed tetanus toxoid–containing vaccines received and the type of wound.
- For clean and minor wounds, a booster is needed if the last dose was more than 10 years ago.
- For contaminated wounds, a booster is recommended if more than 5 years have elapsed since the last dose. Considering the patient's last DTaP vaccine was in 2016, and assuming the wound is clean and minor, no tetanus booster is required at this time. However, if the wound is contaminated, a Td or Tdap booster would be necessary due to the elapsed time since the last dose. The wound should be thoroughly cleaned with soap and water, and debris should be removed. Depending on the severity of the laceration, the wound may require closure with sutures, staples, or adhesive strips. Antibiotic prophylaxis may be considered for heavily contaminated wounds, as recommended by the guide to tetanus prophylaxis in routine wound management 1.
From the FDA Drug Label
Guide to Tetanus Prophylaxis in Wound Management(3 ) History of Tetanus Immunization (Doses)Clean, Minor WoundsAll Other Wounds* Td†TIG‡TdTIG Uncertain or less than 3YesNoYesYes 3 or more§No¶NoNo#No
The patient's last DTaP was in 2016, which is more than 5 years but less than 10 years ago for a minor wound, but since this is a skin laceration, it is considered an other wound.
- The patient has had more than 3 doses of tetanus toxoid (as part of the DTaP vaccine).
- According to the table, for other wounds and more than 3 doses, the recommendation is No to TIG and No to Td if it has been less than 5 years for dirty wounds or less than 10 years for clean wounds since the last dose. Since it has been more than 5 years for a dirty wound, the patient should receive a Td booster. Key points:
- The patient needs a Td booster.
- The patient does not need Tetanus Immune Globulin (TIG) 2.
From the Research
Skin Laceration and DTaP Vaccination
- The last DTaP vaccination was in 2016, which is more than 5 years ago.
- According to the studies, there is no specific recommendation for a booster shot after a skin laceration if the last DTaP vaccination was more than 5 years ago 3, 4.
- However, it is recommended to assess the risk of tetanus and diphtheria exposure and consider a booster shot if necessary 5, 6.
- The safety and efficacy of Tdap vaccination have been studied in various populations, including adults and pregnant women 3, 4, 5.
- The studies suggest that Tdap vaccination is safe and effective in preventing pertussis, but the cost-effectiveness of vaccination in adults is still a topic of debate 6.
Considerations for Tdap Vaccination
- The risk of tetanus and diphtheria exposure should be assessed, and a booster shot should be considered if necessary 5, 6.
- The safety and efficacy of Tdap vaccination should be considered, particularly in adults and pregnant women 3, 4, 5.
- The cost-effectiveness of Tdap vaccination in adults should be taken into account, particularly in relation to the risk of pertussis exposure 6.
- The potential interference of tetanus immune globulin with the immune response to simultaneous administration of tetanus-diphtheria vaccine should be considered 7.