Emergency War Surgery NATO Handbook: Part II: Response of the Body to Wounding: Chapter XI: Infection
United States Department of Defense
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In 1984, the Committee on Trauma of the American College of Surgeons published recommendations, concerning prophylaxis against tetanus and the management of wounds. Immunization in adults requires at least three injections of toxoid. A routine booster of absorbed toxoid is indicated every 10 years thereafter. Combined tetanus and diphtheria toxoid is recommended for routine or post-wounding boosters.
In individuals not adequately immunized (that is, the patient who has received only one or no prior injections of toxoid or the immunization history is unknown), 0.5 ml absorbed tetanus toxoid should be given for nontetanus-prone wounds. For tetanus-prone wounds, 0.5 ml absorbed toxoid and 250 units or more of human tetanus immune globulin should be given, using different syringes, needles, and sites of injection. Completion of the series of toxoid immunizations should then follow.
When the medical officer has determined that the casualty has been previously fully immunized and the last dose of toxoid was given within 10 years, no booster of toxoid is indicated for nontetanus-prone wounds. For tetanus-prone wounds and if more than five years have elapsed since the last dose, 0.5 ml absorbed toxoid should be given. When the patient has had three prior injections of toxoid and received the last dose more than 10 years previously, 0.5 ml absorbed toxoid for both tetanus-prone and nontetanus-prone wounds should be given.
Passive immunization with tetanus immune globulin must be considered individually for each patient. Characteristics of the wound, the conditions under which it was incurred, its treatment, and the patient's age should all be considered. Immunization with human immune globulin is not indicated if the patient has ever received two or more injections of toxoid and the wound is less than 24 hours old. An injection of human immune globulin is indicated if the wound is felt to be a tetanus-prone wound more than 24 hours old and only two prior toxoid injections have been administered. An injection of human immune globulin is also indicated for patients with tetanus-prone wounds who have not received any prior toxoid injections or only one prior injection.
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