See also

Lacerations
Australian Immunisation Handbook

Key points

1. All wounds, other than clean minor ones, should be considered tetanus-prone
2. Check immunisation history and immunise if incomplete or uncertain
3. Tetanus immunoglobulin (TIG) may be required if child has an incomplete primary immunisation course or an uncertain tetanus immunisation history

Background

• Tetanus is rare in Australia because of high vaccination coverage
• Symptoms of tetanus can include spasms of the jaw muscles, trouble swallowing, painful muscle spasms and muscle stiffness, seizures, headache and difficulty swallowing/breathing. It can require sedation or prolonged ventilation in ICU. It can be fatal in a small number of cases
• The recommended schedule for tetanus immunisation is doses at 2, 4, 6, 18 months and 4 years of age, with a further booster at 12-13 years
• A complete primary course of tetanus immunisation is ≥3 doses
• Tetanus-toxoid vaccines are only available in Australia as combination vaccines that include other antigens such as pertussis and diphtheria

Assessment

Tetanus-prone wounds:

• Any wound other than a clean, minor cut
• Compound fractures
• Bite wounds
• Deep penetrating wounds
• Wounds containing foreign bodies (especially wood splinters)
• Wounds complicated by pyogenic infections
• Wounds with extensive tissue damage (eg contusions or burns)
• Any wound obviously contaminated with soil, dust or horse manure (especially if topical disinfection is delayed more than 4 hours)
• Reimplantation of an avulsed tooth

Take an immunisation history, discussing the need for catch-up immunisations where appropriate. A child's immunisation history statement is available for parents (or children >14 years old) through myGov or for health professionals via the child's My Health Record. It can also be obtained from the Australian Immunisation Register (AIR) via Health Professional Online Services (HPOS) or the AIR enquiries line (1800 653 809)

Management

Wounds must be cleaned, disinfected and treated surgically if appropriate

Guide to tetanus prophylaxis in wound management

* The recommended dose for TIG is 250 IU IM. Give as soon as practicable after the injury. If more than 24 hours have elapsed, 500 IU should be given. Because of its viscosity, TIG should be given slowly using a 23 gauge needle. Administer large volumes in divided doses at different sites. If giving at the same time as the tetanus vaccine, give into opposite limb

TIG reactions are very uncommon. Possible reactions include pain, redness and stiffness at injection site. Rarely mild fever, chills, drowsiness or itchy rash. Seek expert advice if known antibodies to IgA or previous history of allergy to immunoglobulin products

NB Children with a significant humoral immune deficiency or HIV require TIG for all tetanus-prone wounds. Discuss with senior doctor or immunology team

Tetanus vaccines

In Australia, tetanus-toxoid vaccines are only available in combination with diphtheria toxoid, acellular pertussis +/- other antigens (see table below)

If available, complete the vaccination schedule for tetanus with the same vaccine brand. If not available, use an alternative brand of the same antigen combination

                                                                                                                                                                                                                                                                                                                                                              Table adapted from Melbourne Vaccine Education Centre

DTPa – diphtheria, tetanus, acellular pertussis

dTpa – less diphtheria toxoid and pertussis antigens than DTPa. For use for >10 years of age

polio/IPV – injectable polio vaccine

hep B – hepatitis B

Hib – Haemophilus influenzae type B

* ATAGI recommends the use of Infanrix hexa and Vaxelis in children up to the age of 10 years. However, some centres recommend them for children up to 18 years of age in instances where multiple vaccines are required (eg catch up, post chemotherapy/post HSCT)

Immunisation side effects

• Common:
  • Infants and young children: mild fever, unsettled behaviour, drowsiness
  • Older children: pain, redness and swelling at injection site
• Very rare: anaphylaxis, urticaria, peripheral neuropathy

Consider transfer when

Child requiring care beyond the comfort level of the hospital

For emergency advice and paediatric or neonatal ICU transfers, see Retrieval Services

Consider discharge when

Wound has been treated and tetanus prevention given

Follow-up for catch-up immunisations has been arranged

Parent information sheet

Tetanus prone wounds

Wound care

Reference list

1. Australian Immunisation Handbook. Retrieved from https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/tetanus (viewed 6 April 2025)
2. Melbourne Vaccine Education Centre. Retrieved from https://mvec.mcri.edu.au/references/tetanus-prone-wounds-management (viewed 26 April 2025)
3. MIMS. Tetanus Immunoglobulin-VF CMI. Retrieved from https://www.nps.org.au/assets/medicines/92c5feda-7514-4151-a248-a53300ff6001.pdf (viewed 6 April 2025)

Last updated October 2025