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Patient vaccinated: give booster if needed

Patient not vaccinated: give antitetanus serum and start dose of tetanus toxoid vaccine (separate syringes, separate sites)

Antitetanus serum for adults and children give booster if needed
Tetanus immunoglobulin (human) 250 units IM, increased to 500 units if any of the following conditions apply:

  • wound older than 12 hours
  • presence or risk of heavy contamination
  • patient weight more than 90 kg


ADULTS and CHILDREN over 7 years:

  • tetanus toxoid (TT) or tetanus and diphtheria vaccine (Td)

CHILDREN under 7 years:

  • Diphtheria and tetanus vaccine (DT). Higher diphtheria toxoid content
Dose of TT or Td When to give Expected duration of protection
1 As early as possible None
2 At least 4 weeks after TT 1 1-3 years
3 At least 6 months after TT 2 At least 5 years
4 At least 1 year after TT 3 At least 10 years
5 At least 1 year after TT 4 Booster every 10 years
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