When should I consider administering tetanus immunoglobulin in addition to the vaccine?

Consider administering tetanus immunoglobulin (HTIG) in addition to the tetanus vaccine in the following situations:

• For any tetanus-prone or high-risk tetanus-prone wound, especially if the person has not received an adequate priming course of tetanus vaccine (at least 3 doses), or their immunization status is unknown or uncertain, give tetanus vaccine plus one dose of HTIG in a different site.
• For people who have received an adequate priming course but the last dose was more than 10 years ago, and who have a high-risk tetanus-prone wound, administer tetanus vaccine plus HTIG.
• For children aged 5–10 years who have received an adequate priming course but no preschool booster, and who have a high-risk tetanus-prone wound, administer tetanus vaccine plus HTIG.
• If HTIG is not available in primary care, refer the person to the A&E department. Human normal immunoglobulin (HNIG) may be used as an alternative to HTIG.
• Consider additional boosting and/or immunoglobulin in people who are fully immunized but severely immunosuppressed, as they may not be adequately protected against tetanus.

In all cases, continue with the recommended vaccination schedule to ensure future immunity.

Definitions: High-risk tetanus-prone wounds include wounds with heavy contamination (e.g., soil or manure), wounds with extensive devitalized tissue, puncture wounds, wounds containing foreign bodies, compound fractures, wounds or burns with systemic sepsis, and certain animal bites or scratches.

Tetanus immunoglobulin is given to provide immediate passive immunity against tetanus toxin, especially when the risk of infection is high and the person's active immunity may be insufficient.

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