Immunology & Infection: Traumatic Infection Prophylaxis

Tetanus (Clostridium tetani)

High Risk Wounds

  • > 6 Hours Old
  • Obvious Contamination (Dirt, Feces, Soil)
  • Devitalized/Necrotic Tissue
  • Penetrating/Puncture Wounds > 1 cm Deep
  • Crush, Burn or Frostbite Wounds

Postexposure Prophylaxis (PEP)

  • Indications for PEP:
    • Unknown Vaccination Status
    • < 3 Doses of Vaccine (Primary Series Alone is Only 2 Doses)
    • > 5 Years Since Last Booster (Consider > 10 Years for Low Risk Wounds)
  • Use: Tetanus Toxoid Vaccine (DT, Tdap, etc.)
    • Also Give Tetanus Ig if a High-Risk Wound

Rabies Virus

Animal Testing

  • Animal Euthanized
  • Head Sent to Public Health Lab
  • Brain Stem Tested for Viral Antigens & Eosinophilic Cytoplasmic Inclusions (Negri Bodies)

Management

  • Low-Risk Wild Animal: None
  • High-Risk Wild Animal:
    • Animal Unavailable: Start Prophylaxis
    • Animal Available: Test Animal
      • If Positive: Start Prophylaxis
      • If Negative: None or Stop
      • *Do Not Wait for Test if on Head/Neck/Trunk
  • Domestic Animal (Dog/Cat)
    • Animal Unavailable: Start Prophylaxis
    • Animal Available: Quarantine Animal for 10 Days
      • If Develop Symptoms: Start Prophylaxis & Test Animal
        • Stop if Test is Negative
      • If Remains Healthy: None
  • Unknown: Contact Public Health Authority

Postexposure Prophylaxis (PEP)

  • Not Previously Vaccinated: RIG & Vaccine
    • RIG (Rabies Immunoglobulin) – 20 U/Kg Injected Around the Wound
    • Vaccine – Repeat on Days 0, 3, 7 & 14 (Also Day 28 if Immunosuppressed)
  • Previously Vaccinated: Vaccine
    • Vaccine – Repeat on Days 0 & 3