Tetanus is an idiosyncratic infection caused by the invasion of tetanus bacilli into human wounds. Tetanus bacillus grows and multiplies in an anaerobic environment and produces exotoxin. The general incubation period of tetanus is 6 to 12 days, and individual patients can develop the disease 1 to 2 days after the injury, and the death rate after the attack is up to 20% or more. If active and passive immunization measures are taken, as long as the body’s serum tetanus antibody level reaches 0.01 to 0.1 IU/ml, immune protection can be obtained. There are two methods to prevent tetanus, automatic immunity and passive immunity Automatic immunity method is to use the tetanus bacillus through multi-generation special culture of toxoid (TT) as antigen, injected into the human body, can produce a fairly high antibody. TT is non-toxic, reliable, and does not occur serum allergic reaction. The specific method is: before and after a total of three injections, each 0.5 ml. after the first subcutaneous injection of adsorbed refined tetanus toxoid, an interval of 4 to 8 weeks, and then the second subcutaneous injection, you can obtain basic immunity. If the 3rd injection is given after 6 months to 1 year, a more stable immunity can be obtained. This immunity can be maintained for more than 10 years, and subsequently (e.g., 5 years) an additional injection (0.5 ml) will maintain stable immunity. Tetanus vaccines currently used for active immunization are formulated with tetanus toxoid and include diphtheria, pertussis, and tetanus triple vaccine (DPT), diphtheria and tetanus combination vaccine (DT), tetanus and attenuated diphtheria combination vaccine (Td), and single tetanus toxoid (TT). Passive immunization methods include tetanus antitoxin (TAT) and human tetanus immunoglobulin (TIG) Currently, TAT injection has become a routine for the management of open wounds in most hospital outpatient and emergency departments. However, equine serum proteins are highly allergenic to humans, with a clinical report of a positive skin test rate of 54.2%. Allergic reactions have been reported in both negative skin test direct injections and positive desensitization injections of TAT, and even death due to anaphylaxis is common. Some scholars believe that the risk incidence of TAT injection is even much higher than the risk of tetanus infection. The use of TIG for tetanus prophylaxis abroad has a history of nearly 40 years, and it has also been applied in China in recent years, and no serious allergic phenomena have been found so far. Although the current TIG preparation is complex and costly, TIG has the advantages of safe use, strong neutralizing effect of toxin, and generally no allergic reaction, which is the reason why TIG is now commonly used internationally instead of TAT. How immunization should be administered after injury Clinical research proves that not all traumas are suitable or need to be injected with TAT or TIG, but should be decided according to the individual differences of the injured person and the specific circumstances of the trauma. The U.S. “Tetanus Prevention Program for Principles of Routine Trauma Management” is worthy of reference. 1.For those with small, superficial, clean wounds without foreign bodies or necrotic tissues, no immunity or incomplete immunity, unclear immunization history, and booster immunity for more than 10 years, inject one shot of TAT and receive or complete full immunization or booster immunization at the same time; for those with full immunization and booster immunization for less than 10 years, in principle, no further immunization prophylaxis will be given. 2.Wound large, deep, clean, with the potential possibility of tetanus infection, not immunized or under-immunized, the last booster immunization time more than 10 years, can be reinforced with a shot of TT, at the same time should be on the opposite side of the injection of 250IU of TIG or TAT 1500IU; the last booster immunization time in 5 to 10 years, then only reinforced with a shot of TT. 3.Wound large and deep, contaminated unclean, with a large number of Foreign body, necrotic tissue, or not completely clean wound, not immunized or under-immunized, the last booster immunization has been more than 10 years, should be reinforced with a shot of tetanus toxoid (TT), while the contralateral part of the injection of 500IU of TIG or 3000IU of TAT; the last booster immunization time in 5 to 10 years, then reinforced with a shot of TT. 4, the wound contamination is heavy, in the injection of TT 4, heavy wound contamination, in the injection of TT at the same time, the immune reinforcement time of less than 5 years, it is recommended that TIG 75IU; immune reinforcement time of 5 to 10 years, it is recommended that TIG with 125IU; more than 10 years, TIG recommended dosage of 250IU. 5, although the injection of TIG or TAT for the prevention and treatment of tetanus regardless of the time to obtain good immune effect, but the early injection of TIG or TAT effect is better. Because they can only neutralize the free tetanus toxin in the body, and can not cross the blood-brain barrier. Once the tetanus toxin binds to the nerves, it is difficult to neutralize, thus directly affecting immune efficacy. However, this does not mean that there is no need for TIG or TAT injections in late trauma. On the contrary, trauma with serious contamination level still needs to be injected even if the usual incubation period is exceeded, and even the dose should be increased appropriately. 6, TIG, TAT and TT are all potent drugs for tetanus prevention and treatment, but tetanus bacillus is anaerobic, and it is very easy to grow and multiply in the anaerobic environment inside small and deep wounds. Therefore, the principles of tetanus treatment should also include early and thorough debridement after trauma, improving local circulation, neutralizing free toxin through artificial immunity; controlling and relieving spasm, keeping respiratory ventilation, preventing complications, etc.