Controlling Spread of Tetanus

Table of Contents

A. Isolation and Quarantine Requirements

None.

B. Protection of Contacts of a Case

No immunization or prophylaxis is necessary for contacts of a case. If the patient is hospitalized, Standard Precautions should be used.

C. Preventive Measures

Personal Preventive Measures/Education

Vaccination, including routine childhood vaccination and tetanus-containing boosters beginning at age 11-12 years and continuing every 10 years thereafter, is the best preventive measure against tetanus. (Note: Tdap is recommended as a booster at age 11-12) Diphtheria-containing formulations should always be used and one dose with acellular pertussis vaccine. The Advisory Committee on Immunization Practices (ACIP) recommends that all children receive a routine series of five doses of tetanus- and diphtheria-containing vaccine at ages 2, 4, 6,and 15-18 months followed by a booster at 4-6 years of age. Booster doses of diphtheria and tetanus toxoids should be administered beginning at age 11-12 years (Tdap) (provided at least 5 years have passed since the last dose) and every 10 years thereafter (Td). DTaP and DT should be used in persons < 7 years of age, whereas Td is the preferred preparation for persons > 7 years of age. The Td catch-up schedule for those starting immunization at > 7 years of age consists of 3 doses. The second dose is usually given 1-2 months after the first dose, and the third dose 6 months after the second dose.

There are four vaccines used to prevent diphtheria, tetanus and pertussis: DTaP, Tdap, DT, and Td. Two of these (DTaP and DT) are given to children younger than 7 years of age, and two (Tdap and Td) are given to older children and adults. Several other combination vaccines contain DTaP along with other childhood vaccines. Children should get 5 doses of DTaP, one dose at each of the following ages: 2, 4, 6, and 15-18 months and 4-6 years. DT does not contain pertussis, and is used to complete the series if a child has a valid contraindication to pertussis vaccine. Td is a tetanus-diphtheria vaccine given to adolescents and adults as a booster shot every 10 years, or after an exposure to tetanus. Tdap is similar to Td but also contains protection against pertussis. A single dose of Tdap is recommended to replace one dose of Td. Tdap is licensed for ages 10 through 64 years. Healthcare providers and the public must be educated on the necessity of primary immunization with tetanus-diphtheria toxoid and 10-year booster doses; the hazards of puncture wounds and closed injuries, and the potential need after injury for active and/or passive prophylaxis. Because tetanus is preventable, each case should be considered a failure to vaccinate and should be used as a means of determining how to prevent further failures from occurring. Surveillance information should be used to raise awareness of the importance of immunization and to characterize persons or places in which additional efforts are required to raise immunization levels and decrease disease incidence.

Tetanus prophylaxis in patients with wounds is based on careful assessment of whether the wound is clean or contaminated, the immunization status of the patient, proper use of tetanus toxoid and/or TIG, wound cleaning and where required, surgical debridement and proper use of antibiotics.

Table 1. Guide to Tetanus Prophylaxis in Routine Wound Management

Vaccination History

Clean minor wounds

  

All other wounds (a)

  
  Td*(b)  TIG(c)  TIG(c) TIG(c)

Unknown or < 3

Yes

 No

Yes

Yes
> 3 doses(d)  No(+) No

   No**

   No
Table Notes
  • + Yes if more than 10 years since last dose
  • * Tdap may be substituted for Td if the person has not previously received Tdap and is 10 years or older
  • ** Yes is more than 5 years since last dose

Environmental Measures

Sterilization of hospital supplies will prevent the infrequent instances of tetanus that may occur in a hospital from contaminated sutures, instruments, or plaster casts.  

Iowa Dept. of Public Health, Revised  8/15