Tetanus Immunoglob­ulin – SHORTAGE

Changes in: Tetanus prone and High Risk definitions

Recently there have been supply problems with Human Tetanus Immunoglob­ulin, currently we are using the alternatives below.

Post-Exposure Prophylaxis (Subgam stocks are now short)

  • ≤24hrs from exposure: 750mg (5ml) Subgam IM OR 750mg (3.75ml) Hizentra IM
  • >24hrs from exposure: 1500mg (10ml) Subgam IM OR 1500mg (7.5ml) Hizentra IM

These are much larger volumes than tetanus immunoglobulin and may require several sites for comfort

Tetanus-prone wounds include:

  • Puncture-type injuries: acquired in a contaminated environment and likely therefore to contain tetanus spores e.g. gardening injuries
  • Wounds containing foreign bodies
  • Compound fractures
  • Wounds or burns with systemic sepsis
  • Certain animal bites and scratches – although smaller bites from domestic pets are generally puncture injuries animal saliva should not contain tetanus spores unless the animal has been routing in soil or lives in an agricultural setting

High Risk:

  • Heavy contamination: with material likely to contain tetanus spores e.g. soil, manure
  • Extensive devitalised tissue
  • Wounds or burns that require surgical intervention that is delayed for more than six hours: are high risk even if the contamination was not initially heavy

Tetanus treatment (i.e. actually has tetanus)

  • Patients <50kg – 250mL Vigam IV (= 12.5g Vigam). Vigam Liquid should be infused intravenously at an initial rate of 0.01 – 0.02 mL/kg/minute for 30 minutes. If well tolerated, the rate of administration may be gradually increased to 0.04 mL/kg/minute up to a maximum of 3 mL/minute.
  • Patients > 50kg – 500mL Vigam IV (= 25g Vigam)  – rate of infusion as above

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