Does my child need a tetanus shot?

This question tops the list of the most frequently asked questions to me. My child has been injured (the urgency becomes greater if the offending object was a rusty piece of metal or if the child’s wound was contaminated by dirt)! Doctor, please give him a tetanus shot!

Generally speaking, very few children require tetanus shots, following an injury because most children are fully immunized as per the recommended immunization schedule.

What is tetanus?

Tetanus is a disease that is caused by bacteria that can enter the body through any injury. It can occur following even a minor cut, bruise or puncture. After entering the body, the bacteria multiply and produce toxins that affect the brain and the nervous system. The toxin can result in either severe disease with prolonged hospitalization & residual deficits or even death.

The good news is that it is a highly preventable, if an individual has received the recommended primary immunization schedule with regular booster injections every 10 years.

So, which children require tetanus vaccine after an injury?

Three factors determine the need for a booster dose or whether we need to give a full series:

Previous immunization status

If the child has received at least three doses as part of immunization, then we consider that the child has been fully immunized primarily. Your pediatrician will administer three doses during infancy. If the child misses the primary schedule, your pediatrician will administer catch-up immunization at any age.

When did the child receive the last tetanus shot?

Primarily applies to the booster series. Your pediatrician will administer booster doses between 15-18 months and then once again between four through six years of age.
Adolescents should receive a single dose of Tdap between 11 and 19 years of age and then once every ten years.

Type of Wound

Wounds can be classified as minor or major and clean or contaminated.

Recommendations

Depending on the type of wound (clean vs contaminated), an additional shot may be required if the child has received last tetanus-containing shot more than 5 years or 10 years back.
In rare cases, when the primary immunization is incomplete and the child has suffered a wound that is not clean and minor, we may administer antibodies directly into the wound, additionally

Conclusion

• In general, most children will not require a tetanus shot after an injury.
• Plain tetanus shots are completely outdated.
• We recommend booster dose with DT (diphtheria + tetanus).
• Please consult with your regular pediatric surgeon.

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