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Laceration: Tetanus Vaccine and Immunoglobulin Post-Exposure Prophylaxis

 

Regardless of wound type, no vaccination is needed for patients who have completed the primary vaccine series and the last dose was administered less than 5 years ago (CDC, 2025). 

 

Recommendation 

Post-Exposure Prophylaxis Dosing 

Clean, minor wounds 
  • Tetanus immunoglobulin (TIG) should NOT be administered 
  • Administer tetanus toxoid vaccine if vaccination history:
    • Uncertain 
    • < 3 doses
    • > 3 doses and ≥ 10 years since last dose
  • Tetanus toxoid vaccine: 
    • < 7 years old, DTaP 0.5 mL IM x 1 dose
    • ≥ 7 years old, Tdap 0.5 mL IM x 1 dose or Td 0.5 mL IM x 1 dose 
 
 

 All other wounds

(i.e., contaminated, penetrating or puncture, compound fractures, crush injuries) 
  • Administer tetanus toxoid vaccine plus TIG if vaccination history:
    • Uncertain
    • < 3 doses 
 
 
  • In a fully vaccinated patient (i.e., has had > 3 doses of a tetanus toxoid vaccine), administer a tetanus toxoid vaccine only if their last dose was given > 5 years ago (or if the date of their most recent vaccine is uncertain)
  • TIG 250 units IM as single dose 
    • Administer in lateral aspect of thigh or deltoid muscle of upper arm in an anatomical site distant from tetanus toxoid vaccine 
    • Do not give in gluteal region due to risk of injury to sciatic nerve
 
  • Tetanus toxoid vaccine: 
    • < 7 years old, DTaP 0.5 mL IM x 1 dose
    • ≥ 7 years old, Tdap 0.5 mL IM x 1 dose or Td 0.5 mL IM x 1 dose 
 

 

Center for Disease Control and Prevention. (2025, June 10). Clinical Guidance for Wound Management to Prevent Tetanus. U.S. Department of Health and Human Services. https://www.cdc.gov/tetanus/hcp/clinical-guidance/index.html 

Lexicomp Online, Pediatric and Neonatal Lexi-Drugs. Diphtheria and Tetanus Toxoids. Retrieved Sep 8, 2025 from https:online.lexi.com. 

Lexicomp Online, Pediatric and Neonatal Lexi-Drugs. Tetanus Immune Globulin. Retrieved Sep 8, 2025 from https:online.lexi.com.

These pathways do not establish a standard of care to be followed in every case. It is recognized that each case is different, and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare a pathway for each. Accordingly, these pathways should guide care with the understanding that departures from them may be required at times.

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Laceration: Tetanus Vaccine and Immunoglobulin Post-Exposure Prophylaxis