Question
Prophylaxis of tetanus.
Answer
Tetanus is caused by the exotoxin (tetanospasmin) of Clostridium tetani, a spore-forming anaerobe that contaminates wounds; prophylaxis combines active immunization with wound management and, where needed, passive immunization.
Active immunization: DPT (diphtheria-pertussis-tetanus, containing tetanus toxoid) as part of the routine childhood immunization schedule — 3 primary doses in infancy with booster doses at 18 months, 5 years, and 10 years (Td/TT); pregnant women receive 2 doses of Tetanus Toxoid (TT) (or Td) to protect against neonatal tetanus.
Passive immunization: Human Tetanus Immunoglobulin (HTIG) provides immediate, short-term protection by neutralizing circulating toxin, given in cases of high-risk/contaminated wounds, especially in unimmunized or partially immunized individuals; equine tetanus antitoxin (ATS) may be used where HTIG is unavailable, after a test dose (risk of anaphylaxis/serum sickness).
Wound management (prophylaxis after injury): thorough surgical debridement and cleaning of the wound to remove necrotic tissue and foreign material (removes the anaerobic environment needed for spore germination); tetanus-prone wounds (deep, contaminated, devitalized tissue, delayed presentation) are managed according to the patient’s prior immunization status — a booster dose of TT/Td if the primary course was completed but the last dose was long ago, and TT plus HTIG for the unimmunized/incompletely immunized with a high-risk wound.
General prophylaxis: maintaining aseptic delivery/cord-care practices to prevent neonatal (umbilical) tetanus, and health education about prompt wound care.