Tetanus is a serious disease and all traumatic injuries require proper prophylaxis for tetanus. Wounds caused by animals are high risk wounds for tetanus and therefore rabies prevention goes hand in hand with tetanus prevention.
Specific tetanus management principles.
The classification of tetanus risk corresponding to rabies exposure is:
1. No tetanus risk: exposure without skin mucous membrane damage e.g. rabies class I exposure, intact mucous membrane contaminated with saliva, bat exposure without skin breakdown.
2. Low risk of tetanus: injuries without full skin breakdown e.g. rabies class II exposure wounds. (iii) High risk of tetanus: Injuries with total rupture of the skin mucosa e.g. rabies class III exposure wounds (except intact mucosa contaminated with saliva and no skin breakdown in contact with bats).
Depending on the level of exposure risk, the following recommendations for prophylaxis are followed.
In the first case, no additional prophylaxis for tetanus is required for both low and high risk exposures if full immunisation has been completed previously (3 or more previous doses of tetanus vaccine) and within 5 years of the last tetanus vaccination.
In the second case, if full immunisation was previously completed (3 or more previous doses of tetanus vaccine), but more than 5 but less than 10 years have elapsed since the last tetanus vaccination, no additional tetanus prophylaxis is required for low risk, and one booster dose of tetanus vaccine may be given for high risk exposures.
In the third case, if full immunisation has been completed previously (3 or more previous doses of tetanus vaccine) but it has been more than 10 years since the last tetanus vaccination, a booster dose of tetanus vaccine is required for both low and high risk exposures, and a passive tetanus immunisation preparation is not required.
In the last case, if there is no history of tetanus immunisation or if this is not known, the full immunisation (3 doses of tetanus vaccine) should be completed as soon as possible after a low-risk exposure, and in the case of a high-risk exposure, not only the tetanus passive immunisation preparation should be received but also the full immunisation should be completed.