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Tetanus Prevention after a Disaster

DISASTER INFORMATION

In most settings, a disaster does not increase the risk for tetanus. However, the risk of tetanus among disaster survivors and emergency responders can best be minimized by following standard immunization recommendations and providing proper wound care.

Key points to remember

Patients without a clear history of at least three tetanus vaccinations who have a wound that is anything other than clean and minor NEED tetanus immune globulin (TIG) not just a tetanus toxoid containing vaccine.

Tetanus in the United States is most commonly reported in older people who are less likely to be adequately vaccinated than younger persons. From 2001-2008, about half of 233 cases reported were among people 50 years or older and about a third were among people 65 years or older.

Older women are especially susceptible; a majority of those 55 years or older do not have protective levels of tetanus antibody.

Diabetics are at increased risk. Reported tetanus is about 3 times more common and fatalities are about 4 times more common in diabetics.

Non-acute wounds (e.g., chronic ulcers, gangrene, abscesses/cellulitis) account for about 1 out of 6 cases of reported tetanus; 1 out of 12 reported cases had no reported injury or lesion.

Tetanus Vaccines and TIG for Wound Management
Age (years) Vaccination history Clean, minor wounds All other wounds
0 through 6 Unknown or not up-to-date on DTaP series based on age DTaP DTaP
TIG
Up-to-date on DTaP series based on age No indication No indication
7 through 10 Unknown or incomplete DTaP series Tdap and recommend catch-up vaccination Tdap and recommend catch-up vaccination
TIG
Completed DTaP series AND <5 years since last dose No indication No indication
Completed DTaP series AND ≥5 years since last dose No indication Td, but Tdap preferred if child is 10 years of age

11 years and older

(*if pregnant, see footnote)

Unknown or <3 doses of tetanus toxoid containing vaccine Tdap and recommend catch-up vaccination Tdap and recommend catch-up vaccination
TIG
3 or more doses of tetanus toxoid containing vaccine AND <5 years since last dose No indication No indication
3 or more doses of tetanus toxoid containing vaccine AND 5-10 years since last dose No indication Tdap preferred (if not yet received) or Td
3 or more doses of tetanus toxoid containing vaccine AND >10 years since last dose Tdap preferred (if not yet received) or Td Tdap preferred (if not yet received) or Td

Routine vaccination

Primary series of diphtheria, tetanus, acellular pertussis (DTaP) in infancy and childhood. Recommended schedule is 2, 4, 6 months, 15 through 18 months, and 4 through 6 years. See http://www.cdc.gov/vaccines/parents/infants-toddlers.html.

Booster shot of tetanus, diphtheria, acellular pertussis (Tdap) – single dose – in adolescents aged 11 through 18 years who have completed the recommended childhood DTaP vaccination series and adults aged 19 and older. Adolescents should preferably receive Tdap at 11 or 12 years old. After receipt of Tdap, then a booster shot of tetanus, diphtheria (Td) is recommended every 10 years. See http://www.cdc.gov/vaccines/vpd-vac/pertussis/recs-summary.htm.

For complete Advisory Committee on Immunization Practices (ACIP) recommendations, see http://www.cdc.gov/vaccines/hcp/acip-recs/index.html.

*Pregnant Women: As part of standard wound management care to prevent tetanus, a tetanus toxoid – containing vaccine might be recommended for wound management in a pregnant woman if 5 years or more have elapsed since the previous Td booster. If a Td booster is recommended for a pregnant woman, health-care providers should administer Tdap.

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