Tetanus Prophylaxis for Cat Scratches

Classification of Cat Scratches and Tetanus Risk

Cat scratches are classified as "other wounds" (non-clean wounds) that may be contaminated with dirt, feces, soil, or saliva, similar to puncture wounds and avulsions 1, 3
Cats are coprophagic (feces-eating) animals, which increases the potential risk of tetanus transmission through their scratches 4
While no recent cases of tetanus from cat scratches have been specifically reported, the risk cannot be dismissed due to the nature of the wound 4

The Centers for Disease Control and Prevention recommends that if the last tetanus toxoid-containing vaccine was <5 years ago, no tetanus toxoid-containing vaccine or TIG is needed 1, 5
If the last tetanus toxoid-containing vaccine was ≥5 years ago, the Centers for Disease Control and Prevention recommends administering tetanus toxoid-containing vaccine without TIG 1, 3
For persons aged ≥11 years, the Centers for Disease Control and Prevention prefers Tdap if the person has not previously received Tdap or has unknown Tdap history 6
For persons with documented previous Tdap, either Td or Tdap may be used, according to the Centers for Disease Control and Prevention 6

For pregnant women requiring tetanus prophylaxis, the Centers for Disease Control and Prevention recommends using Tdap regardless of prior Tdap history 6
Persons with HIV infection or severe immunodeficiency who have contaminated wounds should receive TIG regardless of their tetanus immunization history, as recommended by the Centers for Disease Control and Prevention 1, 3
Persons with a history of an Arthus reaction following a previous tetanus toxoid-containing vaccine should not receive a tetanus toxoid-containing vaccine until >10 years after the most recent dose, regardless of wound condition, according to the Centers for Disease Control and Prevention 1, 3

The Centers for Disease Control and Prevention advises not to assume cat scratches are "clean wounds" - they should be treated as contaminated wounds requiring appropriate tetanus prophylaxis 1, 3
When both TIG and tetanus toxoid-containing vaccine are indicated, the Centers for Disease Control and Prevention recommends administering using separate syringes at different anatomical sites 1, 3