Tetanus

March 2018 | by EMauthor

Tetanus immunization has been provided nationally in the UK since 1961. The vaccine is a cell-free toxin extract from a strain of C.tetani. Remember that a tetanus booster takes days-weeks to build immunity so the important decision is actually when to given immunoglobulin.

Key point: give immunoglobulin to all high risk wounds regardless of the immunity state of the patient, or in a tetanus prone wound where primary immunizations are incomplete. Following this, decide when to give a booster

Tetanus-prone wounds include:

•Wounds or burns that require surgical intervention that is delayed for more than 6 hours.

•Wounds or burns that show a significant degree of devitalized tissue or a puncture-type injury, particularly where there has been contact with soil or manure.

•Wounds containing foreign bodies.

•Compound fractures.

•Wounds or burns in patients who have systemic sepsis.

High-risk tetanus-prone wounds

•Those heavily contaminated with material likely to contain tetanus spores and/or extensive devitalized tissue.

Immunity status	Clean Wound	Tetanus prone wound	High risk wound
Fully immunized	Nil required	Nil required	Immunoglobulin
Primary immunizations complete	Nil required	Nil required	Immunoglobulin
Primary immunizations incomplete or boosters not up to date	Tetanus booster and advise completion at GP	Tetanus booster and immunoglobulin	Tetanus booster and immunoglobulin
Not immunized	Give first dose of vaccine and advise completion at GP	Give first dose of vaccine and immunoglobulin	Vaccine and Immunoglobulin

•When prescribing immunoglobulin write: tetanus immunoglobulin human 250 unit i/m

•When prescribing vaccine write: DTP / Repevax 0.5 mL i/m

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