if-hp-phys-moh-cz-guide-wound-tetanus-phophy-ed

Guide to Wound Tetanus Prophylaxis
in Emergency Departments (ED)

Central Zone
Patient management is summarized in Table 1 on page 2; important supplementary information
follows below:
Vaccine Abbreviations:
• dTap (same as Tdap): Reduced diphtheria, regular tetanus toxoid and reduced acellular
pertussis antigens used to generate active immunity.
• TIG (tetanus immune globulin): A blood product containing antibodies providing temporary
passive immunity against tetanus until active immunity can be generated with tetanus toxoid-
containing vaccines such as dTap.
Tetanus Risk: 10,337 cases reported to World Health Organization in 2015. Average of three (3)
cases per year in Canada with six (6) deaths since 2000.
Determining Immunization History with Tetanus Toxoid-Containing Vaccine:
Consult Net Care (doses given before electronic records were kept and in different zones,
provinces, or countries may not appear). Tetanus vaccine was introduced in Alberta in 1947.
o Adults born in Canada after 1947 are generally assumed to have received three (3) or
more doses unless they have deliberately avoided immunization.
o In Alberta, dTap provision to some adults began in 2012.
Providing TIG:
TIG does not require release by the Medical Officer of Health or designate. For questions
concerning indications or availability of TIG, phone:
Provincial Communicable Disease Control
8:30 am to 4:00 pm weekdays 1-855-444-2324
(CDC) Immunization Team
Central Zone Medical Officer of Health
all other days and times 1-403-356-6430
(MOH) On-Call
TIG Locations:
Acute Care Hospital* Refrigerator Location
Red Deer (1 dose in both Lean Track and Minor Treatment),
Emergency Department
Camrose, Vermilion, Wainwright
Rocky Mountain House and Provost Laboratory
Drayton Valley, Drumheller, Olds, Stettler, Vegreville, Wetaskiwin Laboratory Blood Bank
* Acute Care sites without stocked TIG may enquire about availability at a community health centre (see Providing TIG above).
Administration of Tetanus Toxoid-Containing Vaccines and TIG:

Both products are given intramuscularly at separate sites.
TIG Product Replacement:

• Connect Care sites, follow the Central Zone Connect Care product replacement
instructions that are included in the TIG kit.
Medical Officers of Health, Central Zone

moh.central@ahs.ca | www.ahs.ca/czmoh
Rev2023-11
Guide to Wound Tetanus Prophylaxis in Central Zone Emergency Departments (ED) • 2
Table 1: TIG and Tetanus Toxoid-Containing Vaccine1 Decision

A. Tetanus-Prone Wound e.g., crush, puncture, avulsion, burn, soil/feces/saliva
contamination, necrosis, sepsis.
Immunization History
Patient with Tetanus Toxoid- TIG Tetanus Toxoid-Containing Vaccine Decision
Age Containing Vaccine Decision
Uncertain or less than Give dose of dTap in emergency department (ED).
3 doses Yes, Advise contact with local Public /First Nations Health on next
18 years. give in ED business-day if additional dose(s) required to complete
and older three (3) dose tetanus toxoid vaccine primary series.
3 or more doses No
4 If 5 years or more since last dose,4 give dTap in ED.
Uncertain or less than Yes,
3 doses Give dTap in ED. Advise contact with local Public /First
give in ED Nations Health on next business-day.2
7 to 17
years. If 5 years or more since the last dose,4 give dTap in ED.
3 or more doses 4 Advise contact with local Public /First Nations Health on
No
next business-day.2
Uncertain or less than 3 Yes, Advise contact with local Public /First Nations Health on next
doses give in ED
6 months business-day.2
to 6 years. If 5 years or more since the last dose,4 give dTap in ED.
3 or more doses
No
4 Advise contact with local Public /First Nations Health on next
business day.2
less than If infant is not up-to-date for age,3,4 advise contact with local
0, 1 or 2 doses 5, 4
6 months. Public / First Nations Health on next business day.2
B. Clean, Minor Wound

Immunization History
Patient with Tetanus Toxoid- TIG Tetanus Toxoid-Containing Vaccine Decision
Age Containing Vaccine Decision
Give dTap in ED.
Uncertain, or less than Advise contact with local Public /First Nations Health on next
18 years. 3 doses No business-day if additional dose(s) required to complete 3
and older dose tetanus toxoid vaccine primary series.
3 or more doses No If 10 years or more since last dose, give dTap in ED.
Uncertain or less than Give dTap in ED. Advise contact with local Public / First
3 doses No Nations Health on next business-day.2
7 to 17
years. If 10 years or more years since last dose, give dTap in
3 or more doses No ED. Advise contact with local Public /First Nations
Health on next business-day.2
less than Not up-to-date for age3 Advise contact with local Public /First Nations Health on the
7 years. No next business-day.2
1Effective January 1, 2021 dTap replaced Td in all routine adult immunizations.
2Public /First Nations Health Centre will review the need for additional tetanus toxoid and other vaccines.
3The routine tetanus toxoid vaccine schedule is 6 doses, given at 2, 4, 6, 18 mo.; 4-6 yrs.; and 14-16 yrs. The 5th dose is not required if
the 4th dose was given after the 4th birthday.
4For those known to have an immune compromising condition, especially a with humoral immune deficiency (e.g. HIV,
agammaglobulinemia, or hypogammaglobulinemia): TIG, as well as tetanus toxoid-containing vaccine (regardless of the number
of doses previously received or time since a previous dose), should both be given.
5Use mother’s history of immunization at the time of delivery. If mother received less than 3 doses or an unknown number of doses of
tetanus toxoid-containing vaccines, give TIG in emergency department.
Note: Acute care sites without stocked TIG may enquire about availability at a community health centre (see reverse Providing TIG).

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Guide to Wound Tetanus Prophylaxis

in Emergency Departments (ED)

Administration of Tetanus Toxoid-Containing Vaccines and TIG:

TIG Product Replacement:

Medical Officers of Health, Central Zone

Table 1: TIG and Tetanus Toxoid-Containing Vaccine1 Decision

B. Clean, Minor Wound

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