A 45-year-old man steps on a nail this morning. His last tetanus vaccine was 7 years ago. What would you give him?

A 45-year-old man steps on a nail this morning. His last tetanus vaccine was 7 years ago. What would you give him?

• A. Td
• B. Tdap
• C. Hepatitis B vaccine
• D. Antibiotic prophylaxis only

Answer: (B)

Tetanus prophylaxis after a dirty wound hinges on immunization history and how long it’s been since the last tetanus-containing vaccine. If the patient has completed the primary series and the last booster was more than five years ago, a tetanus booster is indicated. In adults, the booster given should also cover pertussis, so the preferred choice is the tetanus toxoid–containing vaccine with pertussis (Tdap) rather than the Td version, provided he hasn’t recently received Tdap. Since his last tetanus-containing vaccine was 7 years ago, giving a Tdap booster renews protection against tetanus and adds pertussis coverage. Antibiotic prophylaxis alone won’t address tetanus risk, and Hepatitis B vaccine isn’t relevant to tetanus exposure.

Tetanus prophylaxis after a dirty wound hinges on immunization history and how long it’s been since the last tetanus-containing vaccine. If the patient has completed the primary series and the last booster was more than five years ago, a tetanus booster is indicated. In adults, the booster given should also cover pertussis, so the preferred choice is the tetanus toxoid–containing vaccine with pertussis (Tdap) rather than the Td version, provided he hasn’t recently received Tdap. Since his last tetanus-containing vaccine was 7 years ago, giving a Tdap booster renews protection against tetanus and adds pertussis coverage. Antibiotic prophylaxis alone won’t address tetanus risk, and Hepatitis B vaccine isn’t relevant to tetanus exposure.