What are the tetanus (Td) vaccination recommendations after a canine bite?

From the Guidelines

A tetanus shot is recommended after a dog bite if you haven't had a tetanus booster within the last 5 years for dirty wounds or 10 years for clean wounds, as per the most recent guidelines from the Advisory Committee on Immunization Practices (ACIP) 1.

Key Considerations

• The risk of tetanus from a dog bite is present due to the potential introduction of Clostridium tetani bacteria into the wound, especially in puncture wounds contaminated with dirt, saliva, or feces.
• The decision to administer a tetanus toxoid-containing vaccine (such as Tdap or Td) and tetanus immune globulin (TIG) depends on the patient's previous tetanus vaccination history and the type of wound.
• For individuals with unknown or uncertain previous tetanus vaccination histories, it is recommended to consider them as having had no previous tetanus toxoid-containing vaccine and manage accordingly 1.

Management Guidelines

• If the patient has had fewer than 3 doses of tetanus toxoid-containing vaccines or the history is unknown, tetanus immune globulin (TIG) should be administered along with the vaccine for all wounds, especially those contaminated with dirt, feces, or saliva 1.
• For individuals who have completed the primary series but are due for a booster, the guidelines recommend a booster dose if more than 5 years have elapsed since the last dose for dirty wounds or more than 10 years for clean wounds 2, 1.
• Tdap is preferred over Td if the patient has not previously received Tdap, especially for individuals aged 11 years and older 1.

Wound Care

• After receiving the tetanus shot, it is crucial to clean the wound thoroughly with soap and water, apply an antibiotic ointment, and cover it with a sterile bandage.
• Monitoring for signs of infection, such as increasing redness, swelling, warmth, or drainage, is essential for early detection and management of potential complications.

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 recommended tetanus shot after a dog bite depends on the patient's history of tetanus immunization.

• If the patient has an uncertain or less than 3 doses of tetanus immunization, they should receive Td and Tetanus Immune Globulin (TIG).
• If the patient has had 3 or more doses of tetanus immunization, the need for a booster dose depends on the time since the last dose and the type of wound.
  • For clean, minor wounds, no booster is needed if the last dose was within 10 years.
  • For all other wounds, a booster is recommended if the last dose was more than 5 years ago. 3

From the Research

Tetanus Shot Recommendations After Dog Bite

• The decision to administer a tetanus shot after a dog bite depends on various factors, including the patient's vaccination history and the severity of the wound 4.
• Current vaccination schedules in developed countries provide prophylaxis for tetanus, but in cases where a reliable vaccination history is not available, tetanus immune globulin (TIG) may be indicated 4.
• If resources are limited, TIG should be reserved for those who would benefit most or those least likely to have protective antibodies 4.
• Studies have shown that booster vaccinations with tetanus-diphtheria-acellular pertussis (Tdap) vaccine are safe and immunogenic in adults, even when administered less than 2 years after a previous tetanus vaccination 5, 6.
• The Tdap vaccine has been shown to elicit a robust antibody response to pertussis antigens, as well as seroprotective concentrations of tetanus and diphtheria antibodies 5, 7.
• However, there is limited research specifically addressing tetanus shot recommendations after dog bites, and more studies are needed to provide definitive guidance on this topic.