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Tetanus-prone wound — MCCQE Part 1 MCQ

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HardWoundsTetanus-prone woundMCCQE Part 1

A 41-year-old has a deep soil-contaminated puncture wound and cannot recall ever completing a tetanus vaccine series. The wound is cleaned and debrided. Which immunoprophylaxis should be given?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Give tetanus vaccine and tetanus immune globulin at separate sites

Give tetanus vaccine alone because immune globulin prevents vaccine response: Vaccine alone does not provide reliable immediate protection in a previously unimmunized person. Give tetanus immune globulin alone and omit active immunization: Immune globulin wanes and cannot replace completion of active vaccination. Give neither product until old immunization records are located: Uncertain records are managed as incomplete when a tetanus-prone wound creates immediate risk. Give tetanus vaccine and tetanus immune globulin at separate sites: Separate-site administration provides immediate neutralizing antibody while beginning durable immunity; the remaining primary series must be completed. Give a booster only if the puncture becomes clinically infected: Tetanus prophylaxis prevents toxin-mediated disease and is not contingent on ordinary wound infection.

Reference: https://www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-part-4-active-vaccines/page-22-tetanus-toxoid.html