Tetanus Prevention and Treatment with Tetanus Immunoglobulin (TIG)

Preventive Use of TIG

• The Centers for Disease Control and Prevention (CDC) recommends TIG for prophylaxis in patients with tetanus-prone wounds who have unknown or incomplete tetanus vaccination history (<3 doses) 1, 2.
• Tetanus-prone wounds include those contaminated with dirt, feces, soil, saliva, puncture wounds, avulsions, and wounds from missiles, crushing, burns, and frostbite 2, 3.
• The standard prophylactic dose is 250 units administered intramuscularly for both adults and children 4.
• When TIG and tetanus toxoid-containing vaccines are administered concurrently, they must be given at separate anatomical sites using separate syringes 4, 5.
• For clean, minor wounds, no TIG is needed regardless of vaccination history 2, 3.
• For tetanus-prone wounds with unknown or <3 doses of tetanus toxoid-containing vaccine, administer both tetanus toxoid-containing vaccine AND TIG 2, 3.
• Persons with HIV infection or severe immunodeficiency who have contaminated wounds should receive TIG regardless of their tetanus immunization history 2, 3.
• In mass-casualty settings with limited TIG supply, priority should be given to persons aged >60 years and immigrants from regions other than North America or Europe who are less likely to have adequate antitetanus antibodies 4.
• Pregnant women follow the same TIG guidelines as non-pregnant adults 6, 7.

Limitations and Contraindications

• Persons with a history of Arthus reaction following a previous dose of tetanus toxoid-containing vaccine should not receive a tetanus toxoid-containing vaccine until >10 years after the most recent dose, regardless of wound condition 2, 5.
• Postexposure chemoprophylaxis with antimicrobials against tetanus is not recommended 4.