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Guidance for the use of tetanus containing vaccines in children
Children presenting to hospital (RHC) with a tetanus prone or high-risk injury.
Medical and nursing staff assessing children presenting with an injury that may be tetanus prone in the ED at RHC.
Tetanus containing vaccines
Tetanus is an acute disease caused by the action of tetanus toxin, released following infection by the bacterium Clostridium tetani.
UK tetanus immunisation Schedule:
In all wounds other than clean minor wounds, the risk of tetanus should be considered. Children who have received their primary immunisations but not had their 1st booster are fully immunised up until the age of 5. A clean wound is a non-penetrating wound with negligible tissue damage and <6 hours old.
Patients who are severely immunosuppressed may not be adequately protected against tetanus, despite having been fully immunised – All should be discussed with ED senior.
Table 1
Tetanus prone: |
High risk- tetanus prone |
Compound fracture |
Heavy contamination with soil or manure |
Deep penetrating wound/ puncture injury |
Wound with extensive tissue damage e.g. contusion or burns |
Wound containing foreign body (especially wood splinters) |
Wound or burns requiring surgery that is delayed >6 hours |
Certain animal bites- agricultural setting |
|
Wounds or burns with systemic sepsis |
|
Table 2
Immediate Treatment |
Later Treatment |
|||
Clean wound |
Tetanus prone |
Tetanus prone + high risk |
||
FULLY IMMUNISED (defined as): Under 5s who have had full primary course* Age 5-10 with primary course* and 1 booster Over 11 years of age and had ≥ 3 doses** and 3rd dose within the last 10 years |
None |
None |
None |
Further doses of vaccine as per usual recommended schedule |
Primary course* UTD but boosters not up to date (includes over 5s with no booster) Fully immunised but last dose >10 years |
None |
Vaccine dose “booster” |
Vaccine dose “booster” + 1 dose TIG in a different site |
Further doses of vaccine as per usual recommended schedule |
Not had full primary course* OR Immunisation status unknown |
Vaccine dose |
Vaccine dose + 1 dose TIG in a different site |
Vaccine dose “booster” + 1 dose TIG in a different site |
Further doses of vaccine as per usual recommended schedule |
* Primary Immunisation – 3 doses of tetanus containing vaccine at least one month apart (usually at 2, 3, and 4 months of age)
** At least 3 doses of tetanus vaccine at appropriate intervals. This definition of “adequate course” is for the risk assessment of tetanus-prone wounds only. The full UK schedule is five doses of tetanus containing vaccine at appropriate intervals.
If tetanus vaccine “booster” required:
Under 10yrs of age – dTap/IPV (Repevax) or DTaP/IPV (Infarix-IPV)
Over 10yrs of age – Td/IPV (Revaxis)
If not had full primary course or status unknown give:
Under 10yrs of age – DTap/IPV/Hib (Infanrix hexa)
Over 10yrs of age – Td/IPV (Revaxis)
Wounds must be thoroughly cleaned and follow assessment above.
If TIG is required give 250IU IM, or 500IU if more than 24 hours have elapsed since injury or there is a risk of heavy contamination or following burns.
If primary immunisation incomplete or vaccination status unknown refer to GP for f/u and completion of immunisation schedule.
Last reviewed: 01 September 2019
Next review: 30 September 2021
Author(s): Dr Laura Clarke, Paediatric Medicine trainee, RHCG
Co-Author(s): Correspondence author: Dr Steve Foster, Consultant in Paediatric Emergency Medicine, RHCG
Approved By: Paediatric Emergency Department