Tetanus – Wounds

Tetanus prone and High Risk definitions

Immunisation schedule

  • Primary: 2, 3 & 4 months old
  • Boosters: 3½ – 5yrs and 13-15yrs


  • Immunisation only started nationwide in the UK in 1961 (people born before 1961 are unlikely to have completed a primary course)
  • Immunocompromised patients are unlikely to produce adequate antibodies
  • Immediate reinforcing dose of vaccine – these patients are expected to have a rapid response to vaccine dose conferring protection


Wounds – what to give

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

Human Tetanus Immunoglob­ulin

Giving human tetanus immunoglob­ulin provides immediate protection, unlike the vaccine that will just help prevent it next time

For prevention: 250IU by intramuscular injection, or 500IU if more than 24 hours have elapsed since injury or there is a risk of heavy contamination or following burns.

During shortage – link


Tetanus Vaccine

If a dose is indicated please follow the below guidance on which preparation to administer:

If tetanus vaccine “booster” required:

Under 10yrs of age – dTap/IPV (Repevax) or DTaP/IPV (Infarix-IPV)

Over 10yrs of age – Td/IPV (Revaxis)

If not had full primary course or status unknown give:

Under 10yrs of age – DTap/IPV/Hib (Infanrix hexa)

Over 10yrs of age – Td/IPV (Revaxis)


Tetanus vaccine is a TOXIOD immunisation , this mean that it is derived from the toxin, not the bacteria, and therefore cannot cause infection. (So it is safe to use in the immunocompromised)


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