A patient with a deep puncture wound who has never received a DTaP vaccination is given both Td and TIG. Another patient with an identical wound and who had 4 DTaP vaccinations as a child and a Td booster 3 years ago is given nothing. Discuss the reasoning behind this.
Fig. 1
Tetanus prophylaxis in Routine Wound Management
| History of tetanus toxoid doses |
Clean, minor wound | All other wounds (1) | ||
| Td (2) | TIG (3) | Td | TIG | |
| Unknown or < 3 | Yes | No | Yes | Yes |
| Three or more | No (4) | No | No (5) | No |
(1) Such as, but not limited to, wounds contaminated with dirt, feces, soil, saliva, etc.: puncture wounds, avulsions, and wounds resulting from missles, crushing, burns, and frostbite.
(2) Tetanus toxoid, diphtheria toxoid (active immunization).
(3) Tetanus Immune Globulin (passive immunization).
(4) Yes, if more than 10 years since last dose.
(5) Yes, if more than 5 years since last dose. (More frequent boosters are not needed and can accentuate side effects.)