Tetanus Prophylaxis for Head Laceration

Assessment of Wound and Vaccination Status

• The Centers for Disease Control and Prevention recommends that patients with head lacerations who have not received a tetanus toxoid-containing vaccine within the past 5 years or have unknown vaccination status should be administered Tdap vaccine 1
• Patients with unknown or uncertain previous tetanus vaccination histories should be considered to have had no previous tetanus toxoid-containing vaccine 1

Vaccine Selection Algorithm

• The Centers for Disease Control and Prevention prefers Tdap over Td for persons aged ≥11 years who have not previously received Tdap or have unknown Tdap history 1
• For persons with documented previous Tdap vaccination who need a tetanus toxoid-containing vaccine, Td should be used 1

Tetanus Immune Globulin (TIG) Administration

• Patients with unknown or incomplete vaccination history (<3 doses) should receive both tetanus toxoid-containing vaccine AND tetanus immune globulin (TIG) 1
• Persons with HIV infection or severe immunodeficiency who have contaminated wounds should receive TIG regardless of their tetanus immunization history 1

Special Considerations

• Adults with a history of Arthus reaction following a previous dose of a tetanus toxoid-containing vaccine should not receive a tetanus toxoid-containing vaccine until >10 years after the most recent dose, even if they have a wound that is neither clean nor minor 5

Completion of Vaccination Series

• For patients who have never been vaccinated against tetanus, diphtheria, or pertussis, initiate the 3-dose primary series with Tdap as the first dose, followed by Td at >4 weeks and 6-12 months later 5