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Bites - human and animal - Management
When should I give tetanus prophylaxis?
- Give tetanus prophylaxis as follows:
- Person fully immunized, i.e. has received five doses of vaccine at appropriate intervals: tetanus booster not needed. Consider giving human tetanus immunoglobulin for tetanus-prone wounds where the risk of infection is especially high, e.g. those contaminated with manure or extensive devitalized tissue.
- Primary immunization complete, boosters incomplete but up-to-date: tetanus booster not needed but may be given if booster is due and it is convenient to give now. Consider giving human tetanus immunoglobulin for tetanus-prone wounds where the risk of infection is especially high, e.g. those contaminated with manure or extensive devitalized tissue.
- Primary immunization incomplete, or boosters not up-to-date: give tetanus booster and further doses as needed to complete the recommended schedule (note: if the primary course is interrupted it should be resumed but not repeated). Add human tetanus immunoglobulin if it is a tetanus-prone wound (defined as: a puncture wound; a significant degree of devitalized tissue; contaminated with soil or manure; containing foreign bodies; compound fractures; clinical signs of sepsis; wounds or burns sustained more than 6 hours before surgical treatment). Note: inject tetanus vaccine and immunoglobulin at different sites.
- Not immunized or immunization status uncertain: give an immediate dose of vaccine. Add human tetanus immunoglobulin if it is a tetanus-prone wound (see above). Arrange further doses of tetanus vaccine as needed to complete the recommended five-dose schedule.
Clarification / Additional information
- A total of five doses of tetanus vaccine, administered at the appropriate intervals, is considered to give lifelong immunity.
- Vaccinate the person with a combined tetanus vaccine e.g. tetanus/diphtheria/inactivated polio vaccine, as tetanus vaccine is only available in a combined preparation.
Basis for recommendation
- These recommendations are based on expert opinion from the Department of Health [DH, 2006a].
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