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Aluminum phosphate adsorbed tetanus toxoid should be used for active immunization against tetanus as it is more immunogenic than other preparations.

In the first year of life, diphtheria and tetanus toxoids and pertussis vaccine (DTP), are recommended at ages 2, 4, 6, and 12 months. Diphtheria and tetanus toxoid (Td) are recommended at age 11 to 12 years, but may be given from ages 14 to 16 years (CeDteIS...,Í0I..D.!sease...CoDlr0.! 1995).

A primary series of tetanus immunizations for susceptible adults consists of three doses of combined Td toxoid, with the first two doses given at least 4 weeks apart and the third dose given 6 to 12 months after the second. An incomplete primary series of diphtheria and tetanus toxoids should be completed with Td.

Unvaccinated pregnant women should receive two doses of Td 4 to 8 weeks apart before delivery, preferably during the last two trimesters. Pregnant women who have not had a complete vaccination series should complete the three-dose series.

Boosters every 5 to 10 years are necessary to ensure continued protection in all age groups. Side-effects of tetanus toxoid are mild but uncommon. Routine wound care

All wounds require thorough cleaning and surgical debridement to remove foreign and necrotic material. Although chemoprophylaxis is not always feasible or effective, antibiotics should be prescribed for septic or contaminated wounds. Penicillin or metronidazole both have good activity against Clostridium tetani. The need for tetanus toxoid, with or without human tetanus immunoglobulin, depends on both the condition of the wound and the patient's vaccination history ( Table.!)- The Centers for Disease Control recommend the administration of human tetanus immunoglobulin to all patients with tetanus-prone wounds who are unvaccinated or whose vaccination history is unknown (CeDl§ES...,f0I,..OiS§aS§...C0DÍ[0l 1991). The cost of such a practice in third-world countries is prohibitive and requires re-evaluation.

When tetanus toxoid and human tetanus immunoglobulin are given concurrently, separate syringes, separate sites, and adsorbed toxoid only should be used ( Table

Table 1 Guidelines for tetanus prophylaxis in routine wound management

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