The tetanus vaccine is a cell-free purified toxin that is normally given as part of a combined vaccine.

Tetanus vaccine is currently given in the UK as part of the routine immunisation schedule at:

• 2 months
• 3 months
• 4 months
• 3-5 years
• 13-18 years

This, therefore, provides 5 doses of tetanus-containing vaccine. Five doses is now considered to provide adequate long-term protection against tetanus.

Management of wounds

The Greenbook contains the full criteria. The information below is only an abbreviated summary:

The first step is to classify the wound:

Patient has had a full course of tetanus vaccines, with the last dose < 10 years ago

• no vaccine nor tetanus immunoglobulin is required, regardless of the wound severity

Patient has had a full course of tetanus vaccines, with the last dose > 10 years ago

• if tetanus prone wound: reinforcing dose of vaccine
• high-risk wounds (e.g. compound fractures, delayed surgical intervention, significant degree of devitalised tissue): reinforcing dose of vaccine + tetanus immunoglobulin

If vaccination history is incomplete or unknown

• reinforcing dose of vaccine, regardless of the wound severity
• for tetanus prone and high-risk wounds: reinforcing dose of vaccine + tetanus immunoglobulin