In the context of tetanus prophylaxis for a dirty wound in a patient who received a tetanus booster 7 years ago, which action is recommended?

• A. No prophylaxis is necessary
• B. Only a tetanus toxoid vaccine (Td) is needed
• C. Give a Tdap booster now
• D. Antibiotics alone are sufficient

Answer: (C)

For dirty wounds, protection against tetanus relies on recent tetanus toxoid–containing vaccines. If the last booster was within 5–10 years, you should administer another tetanus toxoid–containing vaccine now to maintain protection; if it’s longer ago or the vaccination status is unknown, you may add TIG. Since this patient had a booster 7 years ago, a tetanus toxoid–containing booster is indicated now, and using a Tdap is preferred in adults to also cover pertussis. TIG isn’t needed because immunization is up to date. Antibiotics alone don’t provide tetanus immunity, and doing nothing would leave the patient at risk.