Active immunization with tetanus toxoid is the most effective means of protection (17). The primary series of tetanus toxoid, administered as DTP vaccine at two, four, and six months and a booster 12 months later, ensures protection in childhood. Additional boosters of tetanus toxoid should be given each decade throughout life with further tetanus prophylaxis after acute wounds, as advocated by the American Academy of Pediatrics Advisory Committee on Immunization Practices (Table 1) (18).

Individuals who have documentation of full primary immunization and appropriate boosters need no tetanus prophylaxis beyond appropriate local wound care for clean minor wounds, but should receive a toxoid booster after a dirty, tetanus-prone injury if the most recent dose was received more than five years before. Patients who are not known to have completed the primary series require a tetanus toxoid booster after any penetrating wound and TIG after a tetanus-prone injury. The prophylactic dose of TIG is 250 to 500 U, given intramuscularly. A human gammaglobulin product, TIG, does not carry the risk of serum sickness seen with equine antitoxin, and skin testing for hypersensitivity is unnecessary.

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