Tetanus guideline

Management of tetanus-prone wounds

• The new Immunisation Schedule recommends that 10-yearly tetanus boosters are no longer required up until the age of 50, provided that the primary series of 3 vaccinations plus 2 boosters have been given. 

  The recommendations for the management of tetanus-prone wounds remain the same.

  Types of wounds likely to favour the growth of tetanus organisms include:

  • compound fractures 
  • deep penetrating wounds 
  • wounds containing foreign bodies (especially wood splinters)
  • wounds complicated by pyogenic infections
  • wounds with extensive tissue damage (eg. contusions or burns)
  • any wound obviously contaminated with soil, dust or horse manure (especially if topical disinfection is delayed more than 4 hours). 
  • Re-implantation of an avulsed tooth is also a tetanus-prone event, as minimal washing and cleaning of the tooth is conducted to increase the likelihood of successful re-implantation.

  Wounds must be cleaned, disinfected and treated surgically if appropriate. 

  History of tetanus vaccination		Type of wound	Tetanus vaccine booster  (see below)	Tetanus immunoglobulin
  3 or more doses	< 5 years since last dose	All wounds	NO	NO
  	5-10 years since last dose	Clean minor wounds	NO	NO
  		All other wounds	YES	NO
  	> 10 years since last dose	All wounds	YES	NO
  < 3 doses or uncertain		Clean minor wounds	YES	NO
  		All other wounds	YES	YES

  A combination vaccine should be used in order to boost community protection against pertussis:

  Please note that CDT and Tetanus Toxoid vaccine are no longer available. 

  • < 8 years old DTPa-IPV (Infanrix-IPV®)
  • > 8 years old dTpa (Boostrix®)

  Can use a diphtheria/ tetanus toxoid vaccine (ADT® ) if pertussis vaccination is contraindicated.