My patient needs a tetanus shot — what kind do I give??
A child cut his hand – should I give a tetanus shot?
Children are vaccinated with Diptheria-pertussus-tetanus (DPT) at: 2, 4, 6 months, with a fourth dose at 12 to 18 months , a fifth dose at 4-6 years, and a sixth dose at 11-16 years.
If a child has received at least 3 doses of vaccine and the last dose is within 5 years additional tetanus toxoid is not needed for any type of wound.
If less than three doses of vaccine have been received an additional dose should be given for any type of wound. For larger, deeper, puncture, or contaminated wounds human Tetanus Immune Globulin (TIG) should be given in addition to a dose of tetanus toxoid.
Is a booster safe to give to a pregnany woman?
Yes. If 1st trimester: Td booster for wound management in pregnant women in certain situations if >5 years have elapsed since the previous Td. If in 2nd-3rd trimester: can administer Tdap instead of Td to add protection against pertussis for the baby.
What form should I give my adult patient?
Tetanus toxoid with a reduced dose of diptheria (Td) is given every ten years, and boosters within five for “tetanus-prone” wounds.
Due to changes in tetanus immunizations scheduling, many adults are missing additional pertusis protection. , Tdap should be given at least once for individuals ages 10-64 when they need a tetanus booster.
Do not give pediatric tetanus and diphtheria toxoid (TD) to an adult. TD contains 8 times as much diphtheria toxoid as Td.
My alcoholic pt sustained a trauma, I’m not sure if he’s gotten a booster in the past. Is it possible to give too many tetanus boosters?
Generally okay. Theories of antibody-antigen buildup causing reactions, however no recent literature or case studies to support this. Article from 1967 recommends, no closer than 1 year for booster shots.
How do I know which wounds are “tetanus prone” to give tetanus immunoglobulin to?
A review article in Journal of trauma in 2005 showed that it is not possible to clinically determine which wounds are tetanus prone. Tetanus immunoglobulin should be reserved for patients with wounds who had never received primary immunization against tetanus.
ACIP guidelines: http://jama.jamanetwork.com/article.aspx?articleid=645958
Edsall G, et al. Excessive Use of Tetanus Toxoid Boosters. JAMA. 1967;202(1):17-19. doi:10.1001/jama.1967.03130140075009.
Rhee P.Tetanus and trauma: a review and recommendations. J Trauma. 2005 May;58(5):1082-8.