Materiały źródłowe

• #1 Tetanus Prophylaxis – PubMed

  https://pubmed.ncbi.nlm.nih.gov/32644434/

  Tetanus is now rare in developed nations due to effective immunization programs, but it remains a threat to all unvaccinated people, especially in undeveloped nations. […] The current Advisory Committee on Immunization Practices recommends for children doses of DTaP or DT at 2, 4, and 6 months of age, with additional doses between 15 and 18 months, and between 4 and 6 years. This regimen is followed by 1 booster of Tdap at age 11 or 12, followed by a booster every 10 years thereafter. […] Tetanus prophylaxis includes understanding and knowing the current tetanus immunization guideline(s), recommendation(s), and indication(s) for prophylaxis. The key to the prevention of tetanus is immunization, identification of those at risk, and proper identification and treatment of wounds and traumatic injuries.

• #1

  https://www.who.int/news-room/fact-sheets/detail/tetanus

  Tetanus can be prevented through immunization with tetanus-toxoid-containing vaccines (TTCV). However, people who recover from tetanus do not have natural immunity and can be infected again. […] Tetanus can be prevented through immunization with tetanus-toxoid-containing vaccines (TTCV), which are included in routine immunization programmes globally and administered during antenatal care contacts. […] To be protected throughout life, WHO recommends that an individual receives 6 doses (3 primary plus 3 booster doses) of TTCV. […] Neonatal tetanus can be prevented by immunizing women of reproductive age with TTCV, either during pregnancy or outside of pregnancy. Additionally, robust medical practices can also prevent tetanus disease including clean delivery and cord care during childbirth, and proper wound care for surgical and dental procedures.

• #1 Tetanus Vaccine Recommendations | Tetanus | CDC

  https://www.cdc.gov/tetanus/hcp/vaccine-recommendations/index.html

  CDC recommends tetanus vaccines for people across the lifespan, including for wound management. […] Follow the recommended immunization schedule to ensure that your patients get the tetanus vaccines that they need. […] CDC recommends routine DTaP vaccination for all infants and children younger than 7 years old. […] Administer a 5-dose DTaP series, 1 dose at each of the following ages: 2 months, 4 months, 6 months, 15 through 18 months, 4 through 6 years. […] CDC recommends routine Tdap vaccination for all adolescents. […] Administer a single dose of Tdap at 11 to 12 years of age. […] CDC recommends vaccination every 10 years for all adults to maintain protection against tetanus. […] Once an adult has received a dose of Tdap, administer Td or Tdap for their booster doses. […] The best way to prevent tetanus is to get vaccinated.

• #1 Summary Guide to Tetanus Prophylaxis in Routine Wound Management – MN Dept. of Health

  https://www.health.state.mn.us/diseases/tetanus/hcp/tetwdmgmt.html

  A primary series consists of a minimum of 3 doses of tetanus- and diphtheria- containing vaccine (DTaP/DTP/Tdap/DT/Td). […] No vaccine or TIG is recommended for infants younger than 6 weeks of age with clean, minor wounds. (And no vaccine is licensed for infants younger than 6 weeks of age.) […] Tdap* is preferred for persons 11 through 64 years of age if using Adacel* or 10 years of age and older if using Boostrix* who have never received Tdap. Td is preferred to tetanus toxoid (TT) for persons 7 through 9 years, 65 years and older, or who have received a Tdap previously. If TT is administered, and adsorbed TT product is preferred to fluid TT. (All DTaP/DTP/Tdap/DT/Td products contain adsorbed tetanus toxoid.) […] Give TIG 250 U IM for all ages. It can and should be given simultaneously with the tetanus-containing vaccine. […] For infants younger than 6 weeks of age, TIG (without vaccine) is recommended for dirty wounds (wounds other than clean, minor). […] Persons who are HIV positive should receive TIG regardless of tetanus immunization history.

• #1 Update on Immunization and Pregnancy: Tetanus, Diphtheria, and Pertussis Vaccination | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/09/update-on-immunization-and-pregnancy-tetanus-diphtheria-and-pertussis-vaccination

  Obstetric care providers should administer the tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine to all pregnant patients during each pregnancy, as early in the 27-36 weeks of gestation window as possible. […] Pregnant women should be counseled that the administration of the Tdap vaccine during each pregnancy is safe and important to make sure that each newborn receives the highest possible protection against pertussis at birth. […] If not administered during pregnancy, the Tdap vaccine should be given immediately postpartum if the woman has never received a prior dose of Tdap as an adolescent, adult, or during a previous pregnancy. […] There are certain circumstances in which it is appropriate to administer the Tdap vaccine outside of the 27-36 weeks of gestation window.

• #1 Tetanus Treatment & Management: Approach Considerations, Initial Supportive Therapy and Wound Care, Pharmacologic Therapy

  https://emedicine.medscape.com/article/229594-treatment

  Prevention of tetanus is accomplished through vaccination with DTP or DTaP at ages 2 months, 4 months, 6 months, 12-18 months, and 4-6 years. […] A tetanus toxoid-containing vaccine is indicated if more than 5 years have passed since the last dose. […] Tetanus immunglobulin (TIG) is further recommended in patients with dirty wounds and no or poorly-documented tetanus vaccine history, incomplete tetanus immunization history, a history of HIV, or immunodeficiency. […] If a previously unvaccinated patient receives at least 2 properly spaced doses of a tetanus toxoid-containing vaccine during pregnancy, including 1 Tdap, the risk for neonatal tetanus is significantly reduced. […] For persons aged 7 years or older who never have been vaccinated against tetanus, diphtheria, or pertussis (ie, have never received any dose of DTP/DTaP/DT or Td), administer a series of 3-4 vaccinations containing tetanus and diphtheria toxoids.

• #1 Tetanus Prophylaxis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK559008/

  Tetanus prophylaxis is determined by previous immunization and classifying low versus high-risk wound(s): unimmunized (less than 3 doses or unknown) versus immunized (greater than 3 doses), low risk (clean and minor) versus high risk (contaminated, puncture, avulsions, or resulting from missiles, crushing, burns, animal or human bites, or frostbite). […] Prophylaxis should be administered as soon as possible following a wound or traumatic injury and even upon delayed presentation due to the long and variable incubation period of tetanus. […] Tetanus prophylaxis includes understanding and knowing the current tetanus immunization guideline(s), recommendation(s), and indication(s) for prophylaxis. The key to the prevention of tetanus is immunization, identification of those at risk, and proper identification and treatment of wounds and traumatic injuries.

• #1 Tetanus Treatment & Management: Approach Considerations, Initial Supportive Therapy and Wound Care, Pharmacologic Therapy

  https://emedicine.medscape.com/article/229594-treatment

  The following wounds should be considered prone to tetanus: Wounds that have been present for longer than 6 hours, Deep ( 1 cm) wounds, Grossly contaminated wounds, Wounds that are exposed to saliva or feces, stellate, or ischemic or infected (including abscesses), Avulsions, punctures, or crush injuries. […] It is important to review the immunization status of all patients who present to an emergency department for any care (regardless of chief complaint). […] The ACIP recommends vaccination at primary care visits for adolescents aged 11-12 years and for adults aged 50 years, review of vaccination histories, and updating of tetanus vaccination status. […] Worldwide, neonatal tetanus may be eliminated by increasing immunizations in cisgender women of childbearing age and pregnant individuals, and by improving maternity care.

• #1 Tetanus Prophylaxis

  https://emed.ie/Trauma/Wounds/Tetanus.php

  Tetanus-prone wounds: Any wound or burn sustained more than 6 hours […] Any wound or burn at any interval after injury that shows one or more of: significant degree of devitalised tissue, puncture-type wound, contact with soil or manure likely to harbour tetanus organisms, clinical evidence of sepsis. […] Thorough surgical toilet of the wound is essential irrespective of patients tetanus status. […] In the Mx of tetanus-prone wounds, tetanus immunoglobulin of human origin (HTIG) should be used in addition to wound cleansing and, where appropriate, antibacterial prophylaxis and a tetanus-containing vaccine. […] Indications for use of anti-tetanus immunoglobulin: Those with tetanus-prone wounds who have not received at least 3 doses of tetanus toxoid and their last dose within 10 years […] Patients with impaired immunity who suffer a tetanus-prone wound may in addition require anti-tetanus immunoglobulin […] Patients who have suffered a high-risk wound, regardless of vaccine history.

• #1

  https://www.who.int/news-room/questions-and-answers/item/tetanus-immunization

  In emergency situations where there are serious injuries, tetanus immunization has to be taken into consideration. […] Tetanus immunization is usually provided to victims of natural disasters on an as-needed basis for several reasons. […] In summary, tetanus prevention can be achieved during emergencies through: […] Careful cleaning of wounds, both deep and superficial, can substantially decrease the risk of tetanus. Protecting cleaned wounds from recontamination with dressings, and/or topical disinfectants also is important. […] If possible, TT vaccination should be offered to anyone engaged in debris clean-up and construction. For those who have not received TT in the past, or for whom past vaccination is uncertain, a second dose should be administered 4-8 weeks after the first. The first dose will not provide protection to those who have not previously been vaccinated, but will rather prime the body to produce anti-tetanus immunity with the second dose given at-least 4 weeks later.

• #1 Tetanus Shot & Prevention: Wound Care and Immunizations

  https://www.webmd.com/children/vaccines/understanding-tetanus-prevention

  If you have never been vaccinated for tetanus before and you get hurt, youll need a three-dose catch-up vaccination. […] Tetanus is caused by a bacteria that enters the body through broken skin. There are two main ways to prevent tetanus: getting vaccinated and cleaning the wound. If you get hurt and havent had a tetanus vaccine in the last 10 years (or five, if the wound is dirty), then call your doctor to get a tetanus shot right away. […] Cleaning a wound can help prevent tetanus, but a vaccine offers the best protection. […] According to the CDC, all adults should get a tetanus shot every 10 years. […] Getting a tetanus shot within 48 hours of an injury can help prevent tetanus infection. If you don’t get the shot within this timeframe, the risk of developing tetanus increases.

• #1 Clinical Guidance for Wound Management to Prevent Tetanus | Tetanus | CDC

  https://www.cdc.gov/tetanus/hcp/clinical-guidance/index.html

  The best ways to prevent tetanus are vaccination and wound management. […] There are steps healthcare providers can take during wound care to minimize the risk of tetanus. […] Healthcare providers should take the following steps to prevent tetanus: Provide appropriate wound care, Evaluate the patient’s tetanus vaccination status, Assess the need for prophylactic tetanus immune globulin (TIG). […] Healthcare providers shouldn’t use antibiotics (topical or systemic) to try to prevent tetanus after a wound injury (potential tetanus exposure). […] Regardless of wound type, no tetanus vaccination is needed if the patient meets both criteria below: Received last tetanus vaccination less than 5 years ago, Completed the primary vaccine series. […] Vaccination recommended: For all wounds, People with an unknown vaccine history, Unvaccinated people, People with an incomplete tetanus primary series.

• #1 Clinical Guidance for Wound Management to Prevent Tetanus | Tetanus | CDC

  https://www.cdc.gov/tetanus/hcp/clinical-guidance/index.html

  For dirty or major wounds, People with a complete tetanus primary series who received their last tetanus vaccine 5 or more years ago. […] TIG is never indicated for clean and minor wounds. […] For dirty or major wounds, People with an unknown tetanus vaccine history, People who have never received tetanus vaccines, People with an incomplete tetanus vaccine primary series, People with HIV, People with a severe immunodeficiency.

• #1 Tetanus Prophylaxis

  https://emed.ie/Trauma/Wounds/Tetanus.php

  However trivial the wound, ask about the patient’s immune state and offer booster doses to those patients who are not up-to-date and encourage non-immunised people to have a full course. […] Consider TIG (Tetagam) for fully vaccinated patients with: Impaired immunity (e.g. diabetes, immunosuppressed and IV drug use) […] A wound contaminated with stable manure, or extensive devitalised tissue regardless of vaccine status […] HIV positive. […] Prophylactic Adult dose of tetanus immunoglobulin (Tetagam): 250 iu IM: standard dose […] 500 iu IM: if 24 hours since injury, patient 90kg or heavily contaminated wound or burn wound or open fracture wound. […] When simultaneous vaccination and immunoglobulin are needed they should be administered at two different sites. […] For prophylaxis, if intramuscular administration is contra-indicated (coagulation bleeding disorders), the injection can be administered subcutaneously. However, it should be noted that there are no clinical efficacy data to support administration by the subcutaneous route. […] Please Note: Tetagam (immunoglobulin) should not be administered IV (anaphylaxis risk). […] Immunocompromised patients may not respond to vaccination may need immunoglobulin. In the absence of other contraindications, immunocompromised and HIV+ patients can be given tetanus vaccine.

• #1 Table. Guide to tetanus prophylaxis in wound management | The Australian Immunisation Handbook

  https://immunisationhandbook.health.gov.au/resources/tables/table-guide-to-tetanus-prophylaxis-in-wound-management

  Table. Guide to tetanus prophylaxis in wound management […] Give tetanus immunoglobulin to people with a humoral immune deficiency and people with HIV (regardless of CD4+ count) if they have a tetanus-prone injury. This is regardless of the time since their last dose of tetanus-toxoid vaccine. […] People who have no documented history of a complete primary vaccination course (3 doses) with a tetanus-toxoid vaccine should receive all missing doses and must receive tetanus immunoglobulin for tetanus-prone wounds. See Catch-up vaccination.

• #1

  https://www.gov.uk/government/publications/tetanus-advice-for-health-professionals/guidance-on-the-management-of-suspected-tetanus-cases-and-the-assessment-and-management-of-tetanus-prone-wounds

  Treat tetanus prone-wounds with antibiotics (metronidazole, benzylpenicillin or coamoxiclav) depending on clinical severity with a view to preventing tetanus and give a reinforcing dose of tetanus containing vaccine. […] Patients who are severely immunosuppressed may not be adequately protected against tetanus, despite having been fully immunised and additional booster doses may be required. […] Determination of vaccination status using vaccination records remains the preferred method. […] The rationale for using IM-TIG in at-risk individuals is to sufficiently and rapidly raise antibody levels in exposed individuals with antibody levels below the protective threshold, and who are not expected to make a sufficiently rapid memory response to vaccination. […] The recommended dose if intramuscular TIG is: 250 IU for most cases; 500 IU if more than 24 hours have elapsed or there is risk of heavy contamination or following burns. […] If TIG (for intramuscular use) cannot be sourced, HNIG for subcutaneous or intra-muscular use may be given as an alternative.

• #1

  https://www.who.int/news-room/questions-and-answers/item/tetanus-immunization

  If feasible, vaccination with TT-containing vaccine should be offered to all internally displaced people who have not received at least 3 previous doses. […] Because tetanus risk is high in disaster areas, and because the immunization status of most persons will be unknown, it will be worthwhile to provide doses of TT-containing vaccine, even if only one dose can be assured. […] In emergencies where prior tetanus toxoid immunization levels were low, special attention should be given to preventing maternal and neonatal tetanus, by immunizing women of childbearing age and by improving the hygienic conditions under which childbirths take place. Routine immunization of women and children should also be re-established as soon as possible.

• #1 LAC | DPH – Vaccine Preventable Disease Control Program

  http://ph.lacounty.gov/ip/diseases/tetanus/index.htm

  The best way to prevent tetanus is to get vaccinated with DTap, Tdap, or Td. […] Adults should get a tetanus shot every 10 years. […] The best way to protect against Tetanus is to get vaccinated. Tetanus shots are safe and effective at preventing severe infection. […] The tetanus vaccine series, including booster doses, is nearly 100% effective in preventing tetanus. […] CDC recommends that children receive 5 doses of DTaP, usually at the following ages: 2 months, 4 months, 6 months, 15-18 months, 4-6 years before entering kindergarten. […] Adolescents/preteens should receive one dose of Tdap between 11-12 years of age. […] Adults should receive a Td vaccine booster every 10 years. […] A Tdap booster is also recommended during the 3rd trimester of pregnancy. […] Tetanus immune globulin (TIG) is recommended as treatment for persons with tetanus infection. […] Immunization with tetanus toxoid should occur only after the person’s condition is stable.

• #1

  https://www.who.int/news-room/fact-sheets/detail/tetanus

  In countries where national programmes have maintained high immunization coverage for several decades, tetanus incidence rates are very low. […] To sustain MNTE and protect all persons from tetanus, WHO recommends that 6 doses of tetanus-containing vaccine be given to all persons from childhood to adolescence.

• #1 Tetanus – UpToDate

  https://www.uptodate.com/contents/tetanus

  Tetanus prophylaxis following a puncture wound is discussed in detail separately. The following table summarizes the approach to tetanus prophylaxis. Immunization of women who are pregnant or of childbearing age reduces neonatal tetanus mortality by approximately 94 percent. Improving hygiene during home births in resource-limited settings is also likely to play an important role in preventing neonatal tetanus. […] Since Clostridium tetani spores cannot be eliminated from the environment, immunization and proper treatment of wounds and traumatic injuries are crucial for tetanus prevention. […] Tetanus prophylaxis following a puncture wound should be administered to those who are unvaccinated against tetanus, as well as those who were vaccinated against tetanus previously, but who are not up to date with their vaccines.

• #1 Controlling Spread of Tetanus | Health & Human Services

  https://hhs.iowa.gov/center-acute-disease-epidemiology/epi-manual/reportable-diseases/tetanus/controlling

  Healthcare providers and the public must be educated on the necessity of primary immunization with tetanus-diphtheria toxoid and 10-year booster doses; the hazards of puncture wounds and closed injuries, and the potential need after injury for active and/or passive prophylaxis. […] Tetanus prophylaxis in patients with wounds is based on careful assessment of whether the wound is clean or contaminated, the immunization status of the patient, proper use of tetanus toxoid and/or TIG, wound cleaning and where required, surgical debridement and proper use of antibiotics. […] Sterilization of hospital supplies will prevent the infrequent instances of tetanus that may occur in a hospital from contaminated sutures, instruments, or plaster casts.

• #1 Tetanus

  https://www.nhs.uk/conditions/tetanus/

  Tetanus is a serious, life-threatening condition caused by bacteria getting into a wound. It’s rare in the UK because the tetanus vaccine has been part of the routine vaccination schedule for many years. […] There is a risk of tetanus if soil or manure containing bacteria gets into a wound, such as a bite, burn or scratch. […] Check with your GP surgery if youre not sure youve been fully vaccinated against tetanus. […] Although tetanus is rare, its important to get a wound checked if it could become infected. […] The best way to avoid getting tetanus is to make sure you’re fully vaccinated against it. […] The tetanus vaccine is given as part of the routine NHS vaccination schedule. […] Tetanus vaccinations may be recommended before travelling if: you’re going to an area where it may be difficult to get medical help quickly and your last vaccine dose was more than 10 years ago.

• #1 Tetanus Prophylaxis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK559008/

  Treatment is supportive as best. Prevention is the best strategy by following immunization guidelines with a booster every 10 years and proper identification and prophylaxis of wounds and traumatic injuries. Vaccinations do give lifelong immunity if such guidelines and recommendations are followed. […] Preventing tetanus infection by tetanus prophylaxis is dependent on the intervention of healthcare teams.

• #2 Tetanus – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/tetanus/symptoms-causes/syc-20351625

  You can prevent tetanus by being vaccinated. […] The tetanus vaccine is given to children as part of the diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP). […] A booster shot is recommended for children at age 11 or 12. This booster is called the Tdap vaccine. […] A booster shot is recommended for adults once every 10 years. […] A booster is recommended during the third trimester of a pregnancy, regardless of the mother’s vaccination schedule. […] Ask your doctor to review your vaccination status regularly. […] Check whether you are current on your vaccination schedule if you are planning international travel.

• #2 Tetanus Shot & Prevention: Wound Care and Immunizations

  https://www.webmd.com/children/vaccines/understanding-tetanus-prevention

  When you hear tetanus, you might relate it to stepping on a rusty nail; however, many injuries can lead to tetanus, and rust doesnt need to be involved. […] The two major ways to prevent tetanus are immunization and wound care. […] In the U.S., there are currently three vaccines that prevent tetanus: DTaP (five-dose series for young children), Tdap (single dose for adolescents or adults), Td or Tdap (booster every 10 years). […] Vaccine protection against tetanus lasts a long time, but it doesnt last forever. Thats why you still need to get a booster shot every 10 years (either the Tdap or Td vaccine). […] If the wound is dirty or tetanus-prone and you havent had a tetanus booster shot within the last five years, you should get a booster right away. […] If you get a cut or other open wound, there are two major ways to protect yourself against tetanus: cleaning the wound and getting vaccinated.

• #2

  https://www.who.int/news-room/fact-sheets/detail/tetanus

  In countries where national programmes have maintained high immunization coverage for several decades, tetanus incidence rates are very low. […] To sustain MNTE and protect all persons from tetanus, WHO recommends that 6 doses of tetanus-containing vaccine be given to all persons from childhood to adolescence.

• #2 Tetanus Vaccine Recommendations | Tetanus | CDC

  https://www.cdc.gov/tetanus/hcp/vaccine-recommendations/index.html

  CDC recommends tetanus vaccines for people across the lifespan, including for wound management. […] Follow the recommended immunization schedule to ensure that your patients get the tetanus vaccines that they need. […] CDC recommends routine DTaP vaccination for all infants and children younger than 7 years old. […] Administer a 5-dose DTaP series, 1 dose at each of the following ages: 2 months, 4 months, 6 months, 15 through 18 months, 4 through 6 years. […] CDC recommends routine Tdap vaccination for all adolescents. […] Administer a single dose of Tdap at 11 to 12 years of age. […] CDC recommends vaccination every 10 years for all adults to maintain protection against tetanus. […] Once an adult has received a dose of Tdap, administer Td or Tdap for their booster doses. […] The best way to prevent tetanus is to get vaccinated.

• #2 Tetanus Treatment & Management: Approach Considerations, Initial Supportive Therapy and Wound Care, Pharmacologic Therapy

  https://emedicine.medscape.com/article/229594-treatment

  Prevention of tetanus is accomplished through vaccination with DTP or DTaP at ages 2 months, 4 months, 6 months, 12-18 months, and 4-6 years. […] A tetanus toxoid-containing vaccine is indicated if more than 5 years have passed since the last dose. […] Tetanus immunglobulin (TIG) is further recommended in patients with dirty wounds and no or poorly-documented tetanus vaccine history, incomplete tetanus immunization history, a history of HIV, or immunodeficiency. […] If a previously unvaccinated patient receives at least 2 properly spaced doses of a tetanus toxoid-containing vaccine during pregnancy, including 1 Tdap, the risk for neonatal tetanus is significantly reduced. […] For persons aged 7 years or older who never have been vaccinated against tetanus, diphtheria, or pertussis (ie, have never received any dose of DTP/DTaP/DT or Td), administer a series of 3-4 vaccinations containing tetanus and diphtheria toxoids.

• #2 Update on Immunization and Pregnancy: Tetanus, Diphtheria, and Pertussis Vaccination | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/09/update-on-immunization-and-pregnancy-tetanus-diphtheria-and-pertussis-vaccination

  If a pregnant woman is vaccinated early in her pregnancy (ie, before 27-36 weeks of gestation), she does not need to be vaccinated again during 27-36 weeks of gestation. […] Receipt of Tdap between 27 weeks and 36 weeks of gestation in each pregnancy is critical. […] A woman who did not receive the Tdap vaccine during her most recent pregnancy, but received it previously as an adolescent, adult, or during a prior pregnancy should not receive Tdap postpartum. […] Additionally, adolescent and adult family members and planned caregivers who have not received the Tdap vaccine also should receive Tdap at least 2 weeks before planned infant contact, as previously recommended. […] Since protection from previous vaccination is likely to decrease over time, a Tdap vaccination is necessary during every pregnancy to give the best possible protection to the newborn. […] The Tdap vaccine should replace one dose of Td, preferably given between 27 weeks and 36 weeks of gestation.

• #2 Clinical Guidance for Wound Management to Prevent Tetanus | Tetanus | CDC

  https://www.cdc.gov/tetanus/hcp/clinical-guidance/index.html

  The best ways to prevent tetanus are vaccination and wound management. […] There are steps healthcare providers can take during wound care to minimize the risk of tetanus. […] Healthcare providers should take the following steps to prevent tetanus: Provide appropriate wound care, Evaluate the patient’s tetanus vaccination status, Assess the need for prophylactic tetanus immune globulin (TIG). […] Healthcare providers shouldn’t use antibiotics (topical or systemic) to try to prevent tetanus after a wound injury (potential tetanus exposure). […] Regardless of wound type, no tetanus vaccination is needed if the patient meets both criteria below: Received last tetanus vaccination less than 5 years ago, Completed the primary vaccine series. […] Vaccination recommended: For all wounds, People with an unknown vaccine history, Unvaccinated people, People with an incomplete tetanus primary series.

• #2 Tetanus Prophylaxis

  https://emed.ie/Trauma/Wounds/Tetanus.php

  Tetanus-prone wounds: Any wound or burn sustained more than 6 hours […] Any wound or burn at any interval after injury that shows one or more of: significant degree of devitalised tissue, puncture-type wound, contact with soil or manure likely to harbour tetanus organisms, clinical evidence of sepsis. […] Thorough surgical toilet of the wound is essential irrespective of patients tetanus status. […] In the Mx of tetanus-prone wounds, tetanus immunoglobulin of human origin (HTIG) should be used in addition to wound cleansing and, where appropriate, antibacterial prophylaxis and a tetanus-containing vaccine. […] Indications for use of anti-tetanus immunoglobulin: Those with tetanus-prone wounds who have not received at least 3 doses of tetanus toxoid and their last dose within 10 years […] Patients with impaired immunity who suffer a tetanus-prone wound may in addition require anti-tetanus immunoglobulin […] Patients who have suffered a high-risk wound, regardless of vaccine history.

• #2

  https://www.gov.uk/government/publications/tetanus-advice-for-health-professionals/guidance-on-the-management-of-suspected-tetanus-cases-and-the-assessment-and-management-of-tetanus-prone-wounds

  Effective protection against tetanus can be achieved through active immunisation with tetanus vaccine, which is a toxoid preparation. A total of 5 doses of vaccine at the appropriate intervals are considered to provide lifelong immunity. […] Recovery from tetanus may not result in immunity and vaccination following tetanus is indicated. A full course of tetanus and diphtheria vaccines consists of 5 doses as follows: […] Tetanus-prone wounds include: puncture-type injuries acquired in a contaminated environment and likely therefore to contain tetanus spores, for example gardening injuries; wounds containing foreign bodies such as wound splinters; compound fractures; wounds or burns with systemic sepsis; certain animal bites and scratches. […] Thorough cleaning of wounds is essential, surgical debridement of devitalised tissue in high risk tetanus-prone wounds is crucial for prevention of tetanus. If the wound, burn or injury fulfils the above high risk criteria, IM-TIG or HNIG should be given to neutralise toxin. A reinforcing dose of tetanus-containing vaccine is recommended.

• #2 What Is Tetanus? Symptoms, Causes, Diagnosis, Treatment, and Prevention

  https://www.everydayhealth.com/tetanus/guide/

  Doctors can also use medicine to help prevent tetanus in cases where someone is seriously hurt and doesn’t have protection from tetanus vaccines. […] Puncture wounds or other deep cuts, animal bites, or particularly dirty wounds put you at increased risk of tetanus infection. Seek medical attention if the wound is deep and dirty, particularly if you’re unsure of when you were last vaccinated. […] Your doctor may need to clean the wound, prescribe an antibiotic, and give you a booster shot of the tetanus toxoid vaccine. […] If you have a minor wound, these steps will help prevent tetanus: Control the bleeding. Apply direct pressure to control bleeding. […] Keep the wound clean. After the bleeding stops, rinse the wound thoroughly with clean running water. Clean the area around the wound with soap and a washcloth. If something is embedded in a wound, see your doctor.

• #2 Clinical Guidance for Wound Management to Prevent Tetanus | Tetanus | CDC

  https://www.cdc.gov/tetanus/hcp/clinical-guidance/index.html

  For dirty or major wounds, People with a complete tetanus primary series who received their last tetanus vaccine 5 or more years ago. […] TIG is never indicated for clean and minor wounds. […] For dirty or major wounds, People with an unknown tetanus vaccine history, People who have never received tetanus vaccines, People with an incomplete tetanus vaccine primary series, People with HIV, People with a severe immunodeficiency.

• #2 Tetanus Prophylaxis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK559008/

  Tetanus prophylaxis is determined by previous immunization and classifying low versus high-risk wound(s): unimmunized (less than 3 doses or unknown) versus immunized (greater than 3 doses), low risk (clean and minor) versus high risk (contaminated, puncture, avulsions, or resulting from missiles, crushing, burns, animal or human bites, or frostbite). […] Prophylaxis should be administered as soon as possible following a wound or traumatic injury and even upon delayed presentation due to the long and variable incubation period of tetanus. […] Tetanus prophylaxis includes understanding and knowing the current tetanus immunization guideline(s), recommendation(s), and indication(s) for prophylaxis. The key to the prevention of tetanus is immunization, identification of those at risk, and proper identification and treatment of wounds and traumatic injuries.

• #2 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Tetanus-Prevention.aspx

  It is important to be aware that patients may need additional care, even if they have been vaccinated in the past 10 years, particularly if they have a deep or dirty wound. […] Additionally, most individuals who are traveling to areas when tetanus infections may be more common should be advised to have their immunity status up to date. […] All wounds should be cleaned thoroughly by rinsing them with clean water and washing the area surrounding the wound with an appropriate agent. […] Deep and dirty wounds require more attention and may require a booster vaccination to prevent the spread of tetanus. […] People with minor, clean wounds generally do not need a booster shot, provided they have been vaccinated within the last 10 years. […] People with minor, clean wounds that have not been recently vaccinated (within 10 years) should be given a booster shot to provide adequate protection. […] People with deep or dirty wounds may need an additional booster shot if they were last vaccinated more than 5 years ago. […] Minimizing situations that could lead to wounds and the possibility of contracting tetanus is also important to consider in the prevention of the disease.

• #2 Table. Guide to tetanus prophylaxis in wound management | The Australian Immunisation Handbook

  https://immunisationhandbook.health.gov.au/resources/tables/table-guide-to-tetanus-prophylaxis-in-wound-management

  Table. Guide to tetanus prophylaxis in wound management […] Give tetanus immunoglobulin to people with a humoral immune deficiency and people with HIV (regardless of CD4+ count) if they have a tetanus-prone injury. This is regardless of the time since their last dose of tetanus-toxoid vaccine. […] People who have no documented history of a complete primary vaccination course (3 doses) with a tetanus-toxoid vaccine should receive all missing doses and must receive tetanus immunoglobulin for tetanus-prone wounds. See Catch-up vaccination.

• #2 Summary Guide to Tetanus Prophylaxis in Routine Wound Management – MN Dept. of Health

  https://www.health.state.mn.us/diseases/tetanus/hcp/tetwdmgmt.html

  A primary series consists of a minimum of 3 doses of tetanus- and diphtheria- containing vaccine (DTaP/DTP/Tdap/DT/Td). […] No vaccine or TIG is recommended for infants younger than 6 weeks of age with clean, minor wounds. (And no vaccine is licensed for infants younger than 6 weeks of age.) […] Tdap* is preferred for persons 11 through 64 years of age if using Adacel* or 10 years of age and older if using Boostrix* who have never received Tdap. Td is preferred to tetanus toxoid (TT) for persons 7 through 9 years, 65 years and older, or who have received a Tdap previously. If TT is administered, and adsorbed TT product is preferred to fluid TT. (All DTaP/DTP/Tdap/DT/Td products contain adsorbed tetanus toxoid.) […] Give TIG 250 U IM for all ages. It can and should be given simultaneously with the tetanus-containing vaccine. […] For infants younger than 6 weeks of age, TIG (without vaccine) is recommended for dirty wounds (wounds other than clean, minor). […] Persons who are HIV positive should receive TIG regardless of tetanus immunization history.

• #2

  https://www.gov.uk/government/publications/tetanus-advice-for-health-professionals/guidance-on-the-management-of-suspected-tetanus-cases-and-the-assessment-and-management-of-tetanus-prone-wounds

  Treat tetanus prone-wounds with antibiotics (metronidazole, benzylpenicillin or coamoxiclav) depending on clinical severity with a view to preventing tetanus and give a reinforcing dose of tetanus containing vaccine. […] Patients who are severely immunosuppressed may not be adequately protected against tetanus, despite having been fully immunised and additional booster doses may be required. […] Determination of vaccination status using vaccination records remains the preferred method. […] The rationale for using IM-TIG in at-risk individuals is to sufficiently and rapidly raise antibody levels in exposed individuals with antibody levels below the protective threshold, and who are not expected to make a sufficiently rapid memory response to vaccination. […] The recommended dose if intramuscular TIG is: 250 IU for most cases; 500 IU if more than 24 hours have elapsed or there is risk of heavy contamination or following burns. […] If TIG (for intramuscular use) cannot be sourced, HNIG for subcutaneous or intra-muscular use may be given as an alternative.

• #2 People with a tetanus-prone wound and a humoral immune deficiency (including HIV) are recommended to receive tetanus immunoglobulin | The Australian Immunisation Handbook

  https://immunisationhandbook.health.gov.au/recommendations/people-with-a-tetanus-prone-wound-and-a-humoral-immune-deficiency-including-hiv-are-recommended-to-receive-tetanus-immunoglobulin

  People with a tetanus-prone wound and a humoral immune deficiency (including HIV) are recommended to receive tetanus immunoglobulin. […] People with a humoral immune deficiency and people with HIV (regardless of CD4+ count) are recommended to receive tetanus immunoglobulin if they have a tetanus-prone injury. This is regardless of the time since their last dose of tetanus-toxoid vaccine. […] These people may not have developed or maintained adequate immunity to tetanus, despite vaccination. […] Give tetanus immunoglobulin to people with a humoral immune deficiency and people with HIV (regardless of CD4+ count) if they have a tetanus-prone injury. This is regardless of the time since their last dose of tetanus-toxoid vaccine. […] People who have no documented history of a complete primary vaccination course (3 doses) with a tetanus-toxoid vaccine should receive all missing doses and must receive tetanus immunoglobulin for tetanus-prone wounds.

• #2 Tetanus Medication: Antibiotics, Other, Anticonvulsants, Skeletal Muscle Relaxants, General Anesthetics, Systemic, Immune Globulins, Neuromuscular Blocking Agents, Vaccines, Inactivated, Bacterial

  https://emedicine.medscape.com/article/229594-medication

  The CDC does not recommend use of antibiotics for prophylaxis. However, they should be used in the case of apparent wound infection. […] TIG should also be given in conjunction with prophylactic Tdap vaccination for patients with dirty wounds and poorly-document or no history of tetanus vaccination. […] Administer tetanus toxoid vaccine for wound prophylaxis if the vaccine history is unknown or if fewer than 3 tetanus toxoid immunizations have been administered. […] This vaccine promotes active immunity to diphtheria, tetanus, and pertussis by inducing the production of specific neutralizing antibodies and antitoxins. […] It is indicated for active booster immunization for persons aged 10 or older (Adacel approved for ages 10-64 y, Boostrix approved for ages 10 y or older). It is the preferred vaccine for adolescents scheduled for a booster vaccination.

• #2

  https://www.who.int/news-room/questions-and-answers/item/tetanus-immunization

  If feasible, vaccination with TT-containing vaccine should be offered to all internally displaced people who have not received at least 3 previous doses. […] Because tetanus risk is high in disaster areas, and because the immunization status of most persons will be unknown, it will be worthwhile to provide doses of TT-containing vaccine, even if only one dose can be assured. […] In emergencies where prior tetanus toxoid immunization levels were low, special attention should be given to preventing maternal and neonatal tetanus, by immunizing women of childbearing age and by improving the hygienic conditions under which childbirths take place. Routine immunization of women and children should also be re-established as soon as possible.

• #2 Tetanus in Areas Affected by a Hurricane: Risk, Prevention, and Management Guidance for Clinicians

  https://www.idsociety.org/news–publications-new/cdc-alerts/tetanus-in-areas-affected-by-a-hurricane-risk-prevention-and-management-guidance-for-clinicians/

  Exposure to flood waters does not increase the risk of tetanus, so tetanus immunization campaigns are not needed for evacuees from flooding disasters. […] These workers and residents should make sure they are up-to-date with tetanus vaccination before starting cleanup activities. […] The following steps should be taken to prevent tetanus: […] Unvaccinated persons with any type of wound should start and complete a primary series with an age-appropriate tetanus toxoid-containing vaccine (DTaP, Tdap, or Td) as CDC currently recommends. […] For persons with contaminated wounds, if the last dose of a tetanus toxoid-containing vaccine was received less than 5 years ago, they are considered protected against tetanus and do not require another dose of tetanus toxoid-containing vaccine as part of the current wound management.

• #2 Tetanus – Malaysian Society of Infectious Diseases & Chemotherapy

  https://adultimmunisation.msidc.my/tetanus/

  A dose of Tdap is recommended to be given as soon as feasible to all healthcare workers who have not received Tdap previously. Td boosters are advocated every 10 years thereafter. […] Tetanus vaccination stimulates the production of antitoxin and protects against the toxin produced by Clostridium tetani in contaminated wounds; however, it does not prevent the growth of the organism. […] Complete immunisation (3 primary doses and 2 booster doses) induces protective levels of antitoxin throughout childhood and into adulthood. However, by middle age, about 50% of vaccinated persons will have waned immunity. A single dose of tetanus toxoid produces a rapid anamnestic response in such persons. […] Primary vaccination in adults: Three doses of vaccine are required with an interval of 4-6 weeks between the 1st and 2nd doses, and 6-12 months between the 2nd and 3rd doses. Tdap can be used for the 1st dose with Td vaccine for the subsequent doses. […] Booster vaccination: Persons aged ≥19 years who previously have not received a dose of Tdap should receive a single dose of Tdap. To ensure continued protection against tetanus and diphtheria, booster doses of Td should be administered every 10 years throughout life.

• #2 Tetanus Prophylaxis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK559008/

  Treatment is supportive as best. Prevention is the best strategy by following immunization guidelines with a booster every 10 years and proper identification and prophylaxis of wounds and traumatic injuries. Vaccinations do give lifelong immunity if such guidelines and recommendations are followed. […] Preventing tetanus infection by tetanus prophylaxis is dependent on the intervention of healthcare teams.

• #2 Tetanus Prophylaxis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/37871

  Tetanus toxin is irreversibly bound to tissues, therefore only unbound toxin is available for neutralization. […] The use of passive immunization such as HTIG to neutralize unbound toxin is associated with improved survival, and it is considered to be a standard treatment. […] All tetanus prophylaxis should be used in conjunction with timely cleaning and debridement of wounds. […] Tetanus continues to cause significant mortality in the developing world. […] Prevention is the best strategy by following immunization guidelines with a booster every 10 years and proper identification and prophylaxis of wounds and traumatic injuries. […] Vaccinations do give lifelong immunity if such guidelines and recommendations are followed.

• #3 Tetanus – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/tetanus/symptoms-causes/syc-20351625

  You can prevent tetanus by being vaccinated. […] The tetanus vaccine is given to children as part of the diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP). […] A booster shot is recommended for children at age 11 or 12. This booster is called the Tdap vaccine. […] A booster shot is recommended for adults once every 10 years. […] A booster is recommended during the third trimester of a pregnancy, regardless of the mother’s vaccination schedule. […] Ask your doctor to review your vaccination status regularly. […] Check whether you are current on your vaccination schedule if you are planning international travel.

• #3 What Is Tetanus? Symptoms, Causes, Diagnosis, Treatment, and Prevention

  https://www.everydayhealth.com/tetanus/guide/

  Use antibiotics. After you clean the wound, apply a thin layer of an antibiotic cream or ointment. These antibiotics won’t make the wound heal faster, but they can discourage bacterial growth and infection. […] Cover the wound. Exposure to the air might speed healing, but bandages can keep the wound clean and keep harmful bacteria out. Blisters that are draining are vulnerable. Keep them covered until a scab forms. […] Change the dressing. Apply a new dressing at least once a day or whenever the dressing becomes wet or dirty to help prevent infection.

• #3 People with a tetanus-prone wound and a humoral immune deficiency (including HIV) are recommended to receive tetanus immunoglobulin | The Australian Immunisation Handbook

  https://immunisationhandbook.health.gov.au/recommendations/people-with-a-tetanus-prone-wound-and-a-humoral-immune-deficiency-including-hiv-are-recommended-to-receive-tetanus-immunoglobulin

  People with a tetanus-prone wound and a humoral immune deficiency (including HIV) are recommended to receive tetanus immunoglobulin. […] People with a humoral immune deficiency and people with HIV (regardless of CD4+ count) are recommended to receive tetanus immunoglobulin if they have a tetanus-prone injury. This is regardless of the time since their last dose of tetanus-toxoid vaccine. […] These people may not have developed or maintained adequate immunity to tetanus, despite vaccination. […] Give tetanus immunoglobulin to people with a humoral immune deficiency and people with HIV (regardless of CD4+ count) if they have a tetanus-prone injury. This is regardless of the time since their last dose of tetanus-toxoid vaccine. […] People who have no documented history of a complete primary vaccination course (3 doses) with a tetanus-toxoid vaccine should receive all missing doses and must receive tetanus immunoglobulin for tetanus-prone wounds.

• #3 Tetanus | MSF Medical Guidelines

  https://medicalguidelines.msf.org/en/viewport/CG/english/tetanus-16689919.html

  Pregnant women: if a woman has never been vaccinated or if her vaccination status is unknown: 2 doses of Td during the pregnancy to reduce the risk of tetanus in mother and neonate: the first as soon as possible during the pregnancy and the second at least 4 weeks later and at least 2 weeks before delivery. This vaccination schedule protects more than 80% of neonates from tetanus. A single dose offers no protection.

• #3 Tetanus Prophylaxis – MD Searchlight

  https://mdsearchlight.com/infectious-disease/tetanus-prophylaxis/

  Tetanus Prophylaxis, administration of a tetanus vaccine or immunoglobulin to prevent the development of tetanus infection. […] In developed countries, tetanus is rare because of flourishing immunization programs. However, its essential for everyone to get vaccinated, especially in less developed countries. […] The most important way to prevent tetanus is to get vaccinated, be aware of people at risk, and treat wounds and injuries appropriately. […] Its usually recommended that children receive doses of the DTaP or DT vaccine at 2, 4, and 6 months old, with extra doses given between 15 to 18 months and between 4 and 6 years. […] Adults are also advised to have a Td or Tdap vaccine every 10 years if theyve been fully immunized earlier. […] For those whove never been vaccinated, theyll need three doses of the vaccine.

• #4 Tetanus Prophylaxis – MD Searchlight

  https://mdsearchlight.com/infectious-disease/tetanus-prophylaxis/

  Its important to have a booster every ten years because immunity to the diseases starts to wear off. […] Prevention against tetanus should be provided as soon as possible after a person gets a wound, but it can still be provided even if the person has had the wound for some time, this is due to the unpredictable and potentially long incubation period (the time to develop symptoms) of tetanus. […] Its also important to clean and remove the damaged tissue from all wounds as soon as possible, as part of tetanus prevention. […] If a pregnant woman needs a tetanus shot, she should receive it between 27 to 36 weeks of her pregnancy, regardless of when she had her last shot. […] For individuals with HIV or AIDS, HTIG is typically recommended regardless of their immunization status or the classification of their wound.

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