In case of wounds it is always necessary to evaluate the risk of infection by Clostridium tetani. Factors to be taken into account are for example soil contamination, saliva and the depth of the wound. Deep and dirty wounds are always to be considered at high risk of tetanus infection. How to behave in these cases? After carefully washing the wound at risk, go to the nearest Emergency Department. Indications are as follows, as appropriate.
1) People who have never been vaccinated or with doubtful or unknown vaccination status: they should receive, as soon as possible and in any case within 72 hours of the trauma, an intramuscular administration of tetanus antitoxin (human tetanus immunoglobulin, TIG) for a dosage of 250 units. A double dosage is required in the case of particularly dirty or deep wounds or if the wound is more than 24 hours old, or in adults with above average body weight. In addition, they should undertake a complete tetanus vaccination series with age-appropriate tetanus toxoid-containing vaccine as soon as possible.
2) Persons vaccinated with a complete primary cycle (ie the first 3 doses in infancy). If the last dose of a tetanus toxoid-containing vaccine was received less than 5 years ago, there is no indication for further vaccine administration or tetanus antitoxin administration. Instead, there is an indication to continue with the correct vaccination schedule. If the last dose of a vaccine containing tetanus toxoid was received between the ages of 5 and 10, there is an indication to administer a booster dose with an age-appropriate vaccine but there is no indication to administer an antitoxin. If the last dose of a tetanus toxoid containing vaccine was received more than 10 years ago there is an indication to give an age-appropriate vaccine and antitoxin booster dose if warning symptoms (e.g. shock) are present. ) or more than 24 hours have passed since the injury.
3) Immunosuppressed individuals: Individuals with HIV infection or other forms of primary or secondary severe immunodeficiency who have soiled wounds (including minor wounds) should instead receive a tetanus antitoxin dose regardless of their tetanus vaccination history.
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*Full Professor of Infectious Diseases, Director of the Clinical Unit and Therapy of Highly Diffusive and Antimicrobial Resistant Infections and of the Infectious Diseases Unit of the University Hospital of Pisa, Director of the School of Specialization in Infectious Diseases, University of Pisa, Secretary of the Italian Society of Infectious Diseases and Tropicali (SIMIT), Chair of the ESCMID Study Group for Infections in the Elderly (ESGIE)