Laceration — Tetanus Prophylaxis in Wound Management — Clinical Pathway: Emergency

Laceration Clinical Pathway — Emergency Department

Tetanus Prophylaxis in Wound Management

Previous Doses of
Tetanus Toxoid		 Clean and Minor Wound All Other Wounds1
Tetanus Toxoid-containing Vaccine DTaP, Tdap or Td Human Tetanus
Immune Globulin		 Tetanus Toxoid-containing Vaccine DTaP, Tdap or Td Human Tetanus
Immune Globulin2
< 3 Doses or Unknown Yes No Yes Yes
≥ 3 Doses Vaccinate if last dose given
≥ 10 yrs ago		 No Vaccinate if last dose given
≥ 5 yrs ago		 No
  1. Including wounds contaminated with dirt, feces, soil, and saliva; puncture wounds; avulsions; and wounds resulting from missiles, crushing, burns, and frostbite.
  2. People with human immunodeficiency virus (HIV) infection or severe immunodeficiency who have contaminated wounds should also receive TIG regardless of their history of tetanus immunization.

Table adapted from: Red Book (2018): Report of the Committee on Infectious Diseases  

Vaccine Formulations

DTaP = diphtheria and tetanus toxoids and acellular pertussis

  • Recommended for children < 7 yrs of age

Tdap = tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis

  • Age ≥ 7 yrs who have not completed DTaP vaccine series
  • Age ≥ 11 yrs who have not previously received Tdap

Td = tetanus and diphtheria toxoids

  • May be considered if additional tetanus toxoid-containing doses are needed
  • May be considered for children ≥ 7 yrs of age who are fully vaccinated against tetanus, diphtheria, and pertussis who have been previously vaccinated with Tdap