Postexposure prophylaxis is the provision of medication to prevent disease in persons who are not protected against a particular disease by vaccination but have been exposed to it.
Note: Even minor injuries can be ports of entry for tetanus pathogens or spores and should be cause for the attending physician to review current tetanus immunization protection. Tetanus immunoprophylaxis should be administered immediately. Missing basic immunization vaccinations should be made up according to the recommendations given for basic immunization.
Tetanus immunoprophylaxis in case of injury
| Documented tetanus vaccination status | Time since last vaccination | TDaP/Tdap2.5 | Tetanus immunoglobulin(TIG)3 | |
| Clean minor wounds | Unvaccinated or unknown | Yes | Yes | |
| <3 vaccines | Yes4 | No | ||
| ≥ 3 doses of vaccine | ≥ 10 years | Yes | No | |
| <10 years | No | No | ||
| All other wounds1 | <3 doses of vaccine or unknown | Yes4 | Yes | |
| ≥ 3 doses of vaccine | ≥ 5 years | Yes | No | |
| < 5 years | No | No |
1 Deep and/or contaminated wounds (contaminated with dust, soil, saliva, feces), injuries with tissue fragmentation and reduced oxygen supply or foreign body penetration (e.g., crush, laceration, bite, puncture, gunshot wounds), severe burns and frostbite, tissue necrosis, septic abortions. 2 Children younger than 6 years receive combination vaccine with TDaP; older children and adolescents receive Tdap. Adults also receive Tdap if they have not received pertussis vaccine in adulthood (≥ 18 years) or if there is a current indication for pertussis vaccination.3 TIG = tetanus immunoglobulin. Generally, 250 IU of TIG is administered. TIG is applied simultaneously with the TDaP or Tdap vaccine contralaterally. The TIG dose may be increased to 500 IU for: (a) infected wounds in which adequate surgical treatment is not warranted within 24 h; (b) deep or contaminated wounds with tissue fragmentation and reduced oxygen supply; (c) foreign body penetration (e.g., bite, puncture, or gunshot wounds); (d) severe burns and frostbite, tissue necrosis, and septic abortions. 4 For patients in whom basic immunization has been started but not yet completed (e.g., infants), the interval from the last vaccine dose must be considered. Post-exposure vaccination on the day of wound care is only useful if the interval to the previous vaccine dose is at least 28 days. With regard to the completion of basic immunization, the STIKO’s post-exposure vaccination recommendations also apply. 5 According to communications from the German Social Accident Insurance (DGUV) in April 2018, the costs for tetanus combination vaccinations are generally covered insofar as tetanus prophylaxis is required after an occupational accident according to STIKO recommendations.
