A 16-year-old with knee abrasion; last DTaP booster was at age 4. Which tetanus prophylaxis plan is MOST appropriate?

A 16-year-old with knee abrasion; last DTaP booster was at age 4. Which tetanus prophylaxis plan is MOST appropriate?

• A. Administer tetanus toxoid
• B. Administer adult tetanus and diphtheria toxoid (Td)
• C. Administer diphtheria, tetanus toxoid, and acellular pertussis (Tdap)
• D. Administer tetanus immune globulin

Answer: (C)

In wound management, tetanus protection is guided by how clean the wound is and how up-to-date the person's tetanus-containing vaccines are. For a clean minor wound, if the last tetanus-containing vaccine was more than 10 years ago, a booster is indicated. This 16-year-old last received a DTaP series at age 4, so it's been about 12 years—long enough to warrant a booster. Since the patient has not had a booster in adolescence and needs pertussis protection as well, the best choice is the adolescent booster that also covers pertussis: Tdap. Administering Tdap now provides both tetanus and diphtheria protection and adds pertussis immunity, which is particularly valuable in teens. Tetanus immune globulin is not needed here because vaccination history is established and the wound is not dirty, and TIG is reserved for uncertain or incomplete immunization or certain high-risk dirty wounds. A plain tetanus toxoid product alone isn’t ideal in this age group when an adolescent booster that includes pertussis is appropriate.

In wound management, tetanus protection is guided by how clean the wound is and how up-to-date the person's tetanus-containing vaccines are. For a clean minor wound, if the last tetanus-containing vaccine was more than 10 years ago, a booster is indicated. This 16-year-old last received a DTaP series at age 4, so it's been about 12 years—long enough to warrant a booster.

Since the patient has not had a booster in adolescence and needs pertussis protection as well, the best choice is the adolescent booster that also covers pertussis: Tdap. Administering Tdap now provides both tetanus and diphtheria protection and adds pertussis immunity, which is particularly valuable in teens.

Tetanus immune globulin is not needed here because vaccination history is established and the wound is not dirty, and TIG is reserved for uncertain or incomplete immunization or certain high-risk dirty wounds. A plain tetanus toxoid product alone isn’t ideal in this age group when an adolescent booster that includes pertussis is appropriate.