Most children born in the United States have received five DTap (recommended at 2-, 4-, 6- 15-months and 4-6 years) and one Tdap at age 11-12 because these boosters are part of the usual vaccination schedule. Additional tetanus boosters are given every 10 years. A tetanus booster stimulates the immune system to make antibodies against the tetanus toxin. A tetanus booster may be given to those who have received 3 tetanus boosters in the past. The tetanus booster may be given within 72 hours after the wound occurs.
Tetanus Immune Globulin (TIG) is an antibody that deactivates the tetanus toxin. TIG must be given to those who have not received 3 tetanus toxoid in the past. TIG is also recommended for the treatment of tetanus. However, TIG can only help remove unbound tetanus toxin; it cannot affect toxin bound to nerve endings. A single intramuscular (IM) dose of 3000-5000 units is generally recommended for children and adults, with part of the dose infiltrated around the wound if it can be identified.
Those with lacerations who require treatment to prevent tetanus include: Those who have not had 3 tetanus boosters in the past need a tetanus booster after a skin wound. Those who have not received a tetanus booster in the past 10 years need a tetanus booster after a skin wound. Those who have dirty wounds need a tetanus booster if they have not received a booster in the past 5 years. Dirty wounds include those that occur outdoors, that contain dirt or foreign material, or are caused by bites. As this patient is up to date on her tetanus boosters, she does not require additional tetanus prophylaxis.
Bottom Line: For clean or minor wounds, tetanus toxoid should be given if the last booster was greater than 10 years ago. For contaminated or deep puncture wounds, a booster should be given if the patient’s last one was greater than 5 years ago.