Additional information  For contraindications and precautions to use of a vaccine and for additional information regarding that vaccine, vaccination providers should consult the relevant ACIP statement available online at http://www.cdc.gov/vaccines/pubs/acip-list.htm.  For the purposes of calculating intervals between doses, 4 weeks = 28 days. Intervals of 4 months or greater are determined by calendar months.  Information on travel vaccine requirements and recommendations is available at http://wwwnc.cdc.gov/travel/page/vaccinations.htm.  For vaccination of persons with primary and secondary immunodeficiencies, see Table 13, “Vaccination of persons with primary and secondary immunodeficiencies,” in General Recommendations on Immunization (ACIP), available at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6002a1.htm; and American Academy of Pediatrics. Immunization in Special Clinical Circumstances. In: Pickering LK, Baker CJ, Kimberlin DW, Long SS eds. Red book: 2012 report of the Committee on Infectious Diseases. 29th ed. Elk Grove Village, IL: American Academy of Pediatrics.
Table 94-1 Guide to Tetanus Prophylaxis in Routine Wound Management CLEAN MINOR WOUNDS ALL OTHER WOUNDS* Previous Tetanus Immunization (Doses) DTap, Tdap, or Td† TIG†,‡ DTap, Tdap, or Td TIG‡ ≥3 doses Yes if ≥10 yr since the last tetanus No Yes if ≥5 yr since the last tetanus No toxoid-containing vaccine dose
Modified from American Academy of Pediatrics. Pickering LK, editor: Red Book: 2012 report of the committee on infectious diseases, ed 29, Elk Grove Village, IL, 2012, American Academy of Pediatrics. Tdap, tetanus and diphtheria toxoids, adsorbed (for adolescents >11 yr of age and adults); Td, Tetanus-diphtheria toxoid; TIG, tetanus immunoglobulin. *Such as, but not limited to, wounds contaminated with dirt, feces, soil, or saliva; puncture wounds; avulsions; and wounds resulting from missiles, crushing, burns, and frostbite.
†Tdap is preferred for adolescents who have never received Tdap. Td is preferred to tetanus toxoid for adolescents who received Tdap previously or when Tdap is not available.
‡Immune globulin intravenous should be used if TIG is not available.
contact with the index patient, or medical personnel without direct exposure to the patient’s oral secretions. Rifampin twice daily for 2 days, ceftriaxone once, and ciprofloxacin once (>18 years of age) are the recommended regimens. Azithromycin may be used in the case of resistant organisms.
All postexposure wound treatment begins with immediate, thorough cleansing using soap and water, removal of foreign bodies, and debridement of devitalized tissue. Tetanus prophylaxis after wounds and injuries includes vaccination of persons with incomplete immunization and tetanus immunoglobulin for contaminated wounds (soil, feces, saliva), puncture wounds, avulsions, and wounds resulting from missiles, crushing, burns, and frostbite (Table 94-1).