Summary Guide to Tetanus Prophylaxis in Routine Wound Management

A summary guide to examining wounds for possible tetanus prophylaxis.

1	A primary series consists of a minimum of 3 doses of tetanus- and diphtheria- containing vaccine (DTaP/DTP/Tdap/DT/Td).
2	Age-appropriate vaccine:
	DTaP for infants and children 6 weeks up to 7 years of age (or DT pediatric if pertussis vaccine is contraindicated); Tetanus-diphtheria (Td) toxoid for persons 7 through 9 years of age; and >65 years of age; Tdap for persons 10 through 64 years, unless the person has received a prior dose of Tdap.*
3	No vaccine or TIG is recommended for infants <6 weeks of age with clean, minor wounds. (And no vaccine is licensed for infants <6 weeks of age.)
4	Tdap* is preferred for persons age 10 through 64 who have never received Tdap. Td is preferred to tetanus toxoid (TT) for persons 7 through 9 years, or >65 years, or those who have received a Tdap previously. If TT is administered, an adsorbed TT product is preferred to fluid TT. (All DTaP/DTP/Tdap/DT/Td products contain adsorbed tetanus toxoid.)
5	Give TIG 250 U IM for all ages. It can and should be given simultaneously with the tetanus-containing vaccine.
6	For infants <6 weeks of age, TIG (without vaccine) is recommended for “dirty” wounds (wounds other than clean, minor).
7	Persons who are HIV positive should receive TIG regardless of tetanus immunization history.