The vaccination programme for newborns, young children, and school-aged children includes active immunisation for tetanus using the tetanus phosphate toxoid. If wounded later in life, the treating physician is required to ask about tetanus immunisation injections.
Tetanus prophylaxis is indicated for every non-surgical wound that occurs under non-sterile conditions. The immunisation history of the patient determines whether the patient is actively and/or passively immunised against tetanus completely. We recognise three categories of immunisation status. Complete immunisation refers to active immunisation with tetanus toxoid, administered three times with a period of one month between the first and second injections and six months between the second and third injections. Patients who receive a prophylactic “booster” injection of tetanus toxoid (category II) maintain basic immunity for 20 years.
Having tetanus does not provide immunity. The highly toxic tetanus toxin is present in quantities too small to invoke an antigenic response. Immunity to tetanus can only be achieved through active and/or passive immunisation.
1. Non-vaccinated patients:
- Immediately after trauma:
- 1 ampoule human tetanus immunoglobulin + first vaccination with tetanus toxoid.
- Repeat vaccination 1 and 6 months after the first vaccination.
2. Incompletely vaccinated patients:
- Immediately after trauma:
- 1 ampoule human tetanus immunoglobulin.
- Complete vaccination schedule.
3. Patients who were likely vaccinated more than 20 years ago:
- Immediately after trauma:
- 1 dose tetanus vaccine.
- Men born before 1936 and women born before 1950: 1 dose human tetanus immunoglobulin.
4. Completely vaccinated patients vaccinated more than 10 years ago:
- Immediately after trauma:
- 1 dose vaccine.
5. HIV positive or otherwise immunocompromised patients:
- Treat as non-vaccinated patients.