Tetanus Prophylaxis
The decision of whether a patient requires post-exposure tetanus prophylaxis depends on 1) the patient’s tetanus immunisation status and 2) the type of wound.
Step 1 – Questions to Ask the Patient
The decision regarding whether tetanus PEP is required depends on 2 factors:
- Immunisation status
- Did the patient receive an adequate priming course (≥3 doses of tetanus vaccine), AND
- When was the last dose? Specifically, is the last dose <10 years ago?
- Wound type
Decision-making for tetanus PEP is based on whether the patient has received an adequate priming course, which is defined as ≥3 doses of a tetanus vaccine.
This is not the same as the full UK tetanus immunisation schedule, which consists of 5 doses given at set intervals to provide long-term protection.
Wound Type
| Clean wound | ALL the following:
|
| Tetanus-prone wound | Including any of the following:
|
| High-risk tetanus-prone wound | Any of the tetanus-prone wound features AND any of the following:
|
Step 2 – Decision Algorithm (Does the Patient Need Prophylaxis?)
There are 2 ways to present this decision algorithm.
- The first table is designed for intuitive learning and may be helpful for some students
- The second table is based on the original guideline table, which is also included for reference.
Both tables convey the same core information, so students can choose whichever format suits their learning style best.
Student-Friendly Version
One of the most important things is to learn when PEP is NOT necessary:
- PEP is NOT necessary in only 2 situations:
- Patients received adequate priming <10 years ago
- Patients received adequate priming >10 years ago, and have a clean wound
- All other patients would need some form of PEP – i.e. vaccine booster +/- tetanus immunoglobulin
| Immunisation status | Management |
|---|---|
| Patient received ≥3 doses of tetanus vaccine (adequate priming) | Management depends on when the last dose of vaccine was:
|
| Vaccination status unknown / inadequate priming |
|
Original Guideline Version
| Immunisation status | Clean Wound | Tetanus-prone wound | High-risk tetanus-prone wound |
|---|---|---|---|
| ≥3 doses (adequate priming) + last dose <10 years ago | No PEP required | ||
| ≥3 doses (adequate priming) + last dose >10 years ago | No PEP required | Give a vaccine booster | Give vaccine booster + tetanus immunoglobulin |
| Vaccination status unknown / inadequate priming | Give a vaccine booster | Give vaccine booster + tetanus immunoglobulin | |