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Tetanus toxoid, tetanus toxoid adsorbed, and tetanus immune globulin

  • In children, primary immunization against tetanus is usually done in conjunction with diphtheria and pertussis vaccination using DTaP or a combination vaccine that includes hepatitis B and polio vaccines. A 0.5-mL dose is recommended at 2, 4, 6, and 15 to 18 months of age.
  • Additional doses of tetanus toxoid are recommended as part of traumatic wound management if a patient has not received a dose of tetanus toxoid within the preceding 5 years (Table Tetanus Prophylaxis).
  • In adults or children older than 7 years of age where primary immunization against tetanus alone is needed, a series of three doses of Td is administered intramuscularly; the initial dose is followed by a repeat dose in 1 to 2 months, then the third at 6 to 12 months after the first dose. Boosters are recommended every 10 years.
  • Tetanus toxoid may be given to immunosuppressed patients if indicated.
  • Tetanus immune globulin is used to provide passive tetanus immunization following the occurrence of traumatic wounds in nonimmunized or suboptimally immunized persons (see Table Tetanus Prophylaxis). A dose of 250 to 500 units is administered intramuscularly. When administered with tetanus toxoid, separate sites for administration should be used.
Tetanus toxoid, tetanus toxoid adsorbed, and tetanus immune globulin
TABLE. Tetanus Prophylaxis
 
  Clean, Minor All Other
Vaccination history Td Tetanus immune globulin Td Tetanus immune globulin
Unknown or <3 doses Yes No Yes Yes
3 doses Noa No Nob No
aYes if >10 yr since last dose. bYes if >5 yr since last dose.
TABLE. H. influenzae Type b Conjugate Vaccine Products
Vaccine Trade Name Protein Carrier
HbOC HibTITER (Wyeth Vaccines) Mutant diphtheria toxin protein
polyribosyl-ribitol-phosphate-T ActHIB (Aventis Pasteur) Tetanus toxoid
polyribosyl-ribitol-phosphate-OMP PedvaxHIB (Merck) Neisseria meningitides serogroup B outer membrane protein
Note: The polysaccharide is polyribosyl-ribitol-phosphate.
  • Tetanus immune globulin is also used for the treatment of tetanus. In this setting, a single dose of 3000 to 6000 units is administered intramuscularly.

Tetanus toxoid, tetanus toxoid adsorbed, and tetanus immune globulin

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