ACEP ID:

Tetanus

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Section IconTetanus (Tdap, DTaP, Td)
Overview
Any treatment should include local wound care
Do not administer to patients with severe allergic reaction to a previous dose of tetanus-containing vaccine.
Do not administer to patients with encephalopathy without identifiable cause within 7 days of a previous tetanus vaccination with a pertussis antigen-containing vaccine.
Questions to ask/consider
Exposure:
  • Clean/minor wound or superficial burn
  • Other wound (contaminated, puncture, crush, large) or deep burn
  • Corneal abrasion – no vaccine indicated unless penetrating injury into the eye
Patient age
  • 2mo-6 years – DTaP series
  • 7y and up – Tdap
Pregnancy Status
  • Pregnant women who have sustained at risk wound (such as lacerations) may receive a dose of Tdap if one has not been received during the current pregnancy
  • Tdap-administration during pregnancy-recommended by ACIP
Vaccination status
  • Fully vaccinated (3 or more lifetime tetanus vaccine doses), unvaccinated/partially vaccinated/unknown
HIV (any CD4 count) or severe immunodeficiency
Guidelines
Clean/minor wound or superficial burn (epidermis intact)
  • Fully vaccinated (last within 10 years):
    • No treatment
  • Fully vaccinated (last 10 years or more):
    • Everyone: Tdap (can substitute Td if has received Tdap)
  • Unvaccinated/undervaccinated/unknown
    • 2mo-6y: DTaP (and f/u for series)
    • 7y and older: Tdap (and f/u for series)
Other wound
  • Fully vaccinated (last within 5 years):
    • No treatment
  • Fully vaccinated - (last 10 years or more):
    • Everyone: Tdap (can substitute Td if has received Tdap)
  • Unvaccinated/undervaccinated/unknown
    • 2mo-6y: DTap (and f/u for series) + tetanus immunoglobulin
    • 7y and older: Tdap (and f/u for series) + tetanus immunoglobulin
  • HIV (regardless of CD4) or severe immunodeficiency: Tdap + tetanus immunoglobulin
Recommendations allow either tetanus and diphtheria toxoids (Td) vaccine or Tdap to be used for the decennial Td booster, tetanus prophylaxis for wound management, and for additional required doses in the catch-up immunization schedule if a person has received at least 1 Tdap dose.
  • Please see reference below for link to CDC's updated recommendations
Tetanus Flowchart
References
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