Tetanus Decision Tool | Wound Care Evidence-Based Guide

⚠️ The first step for every wound is thorough cleansing and debridement. This tool generates vaccine / immunoglobulin advice per CDC wound-management recommendations; for pregnancy, immunocompromise and other special situations, involve specialist judgment in parallel.

1. Wound type

"Tetanus-prone wounds" = contaminated (soil/feces/saliva), puncture wounds, avulsions, crush injuries, burns/frostbite, necrotic tissue, missile injuries, and wounds unattended for more than 6 hours.

Clean, minor wound All other wounds (contaminated/puncture/crush/burn…)

2. Tetanus vaccination history (completed a primary series of ≥3 doses?)

Taiwan routine schedule: multiple childhood DTaP doses plus a school-age booster — most adults have completed the primary series; if uncertain, treat as "incomplete / unknown".

Fewer than 3 doses / history unknown Completed ≥3 doses

3. Time since the last tetanus vaccine dose?

If vaccination history is unknown, this question can be skipped (the most conservative approach will be used).

< 5 years 5–10 years > 10 years Can't remember

4. Special situations (select all that apply)

Immunocompromised / HIV (low CD4) Pregnancy Never received Tdap as an adult (pertussis-containing)

CDC Standard Reference Table (quick lookup)

※ Contaminated, puncture, avulsion, crush, burn/frostbite, necrotic, missile wounds, etc. TIG = tetanus immune globulin (human, usually 250 IU IM, at a different site from the vaccine). For adults, prefer Tdap (if a pertussis-containing adult dose has never been given); otherwise use Td.

Vaccine history	Clean minor wound	All other wounds※
Vaccine (Td/Tdap)	TIG	Vaccine (Td/Tdap)	TIG
<3 doses or unknown	✅ Give	❌ Not needed	✅ Give	✅ Give
≥3 doses, last dose <5 years	❌ Not needed	❌ Not needed	❌ Not needed	❌ Not needed
≥3 doses, last dose 5–10 years	❌ Not needed	❌ Not needed	✅ Give	❌ Not needed
≥3 doses, last dose >10 years	✅ Give	❌ Not needed	✅ Give	❌ Not needed

Based on: CDC — Tetanus: For Clinicians / Wound management guidance; WHO tetanus position paper (see the Guidelines Library)

Tetanus Prophylaxis Decision Tool

CDC Standard Reference Table (quick lookup)