In a 32‑year‑old Filipino male with multiple abrasions from rusted pipes who received a Tdap (tetanus, diphtheria, acellular pertussis) booster one year ago, should tetanus immune globulin be administered?

Tetanus Immunoglobulin Not Indicated

No, tetanus immune globulin (TIG) should NOT be administered to this patient. 1

Clinical Reasoning

This 32-year-old male with multiple abrasions from rusted pipes received Tdap one year ago, meaning he has a documented complete primary vaccination series (≥3 lifetime doses) with his most recent dose well within the protective window.

Wound Classification

• Multiple abrasions from rusted pipes are classified as contaminated/tetanus-prone wounds because they may be contaminated with dirt, soil, and debris that harbor Clostridium tetani spores. 1
• This classification determines that the critical interval for booster administration is 5 years rather than the 10-year interval used for clean, minor wounds. 1

Vaccination Algorithm for This Patient

For patients with ≥3 previous doses and contaminated wounds:

• If last dose was <5 years ago: No tetanus toxoid-containing vaccine or TIG is needed. 1
• If last dose was ≥5 years ago: Administer tetanus toxoid-containing vaccine (Tdap preferred) WITHOUT TIG. 1

Since this patient received Tdap only 1 year ago, he falls into the first category and requires neither additional tetanus toxoid nor TIG. 1

Why TIG Is Not Indicated

TIG is reserved for only three specific scenarios: 1, 2

1. Incomplete primary vaccination: Patients with <3 documented lifetime doses of tetanus toxoid
2. Unknown/uncertain vaccination history: Patients who cannot verify their immunization status
3. Severe immunocompromise: HIV infection or severe immunodeficiency with contaminated wounds, regardless of vaccination history 1

This patient meets none of these criteria—he has documented recent Tdap vaccination within the protective window.

Immunologic Basis

• Complete primary vaccination with tetanus toxoid provides nearly 100% protection and long-lasting immunity for at least 10 years in most recipients. 1
• Persons who have received at least two doses of tetanus toxoid rapidly develop antitoxin antibodies after a booster dose. 1
• However, research demonstrates that there is no early antitoxin response within the first 4 days following a booster in previously immunized adults, which is why TIG remains important for those with incomplete or unknown vaccination status. 3

Critical Clinical Pearl

The most common error in tetanus prophylaxis is confusing the 10-year routine booster interval with the 5-year interval for contaminated wounds. 1 Even with this contaminated wound, since the patient's last dose was only 1 year ago (well under 5 years), he remains fully protected and requires no intervention.

Proper Wound Management

• Thorough wound cleaning and debridement to remove debris that might harbor C. tetani spores is the critical first step in tetanus prevention. 2
• Antibiotic prophylaxis is NOT indicated for tetanus prevention in most wounds. 1

What Would Trigger TIG Administration

If this same patient had presented with:

• <3 documented lifetime tetanus doses OR
• Unknown/uncertain vaccination history OR
• Severe immunocompromise (HIV, severe immunodeficiency)

Then he would require BOTH tetanus toxoid-containing vaccine (Tdap preferred) AND TIG 250 units IM at a separate anatomic site using a separate syringe. 1, 4

Documentation Importance

The CDC emphasizes maintaining a personal vaccination record to minimize administration of unnecessary vaccinations, which should document vaccine type, manufacturer, anatomic site, route, date of administration, and administering facility name. 1 This case illustrates why proper documentation matters—it prevents unnecessary TIG administration and potential adverse reactions from over-vaccination.