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  #1  
Old 06-06-2011
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Immunology When to give Tetanus immunoglobulin prophylaxis?

My understanding was that the ONLY case in which we use Tetanus Immunoglobulins is the case of BOTH (dirty wound + Incomplete/nonexistent immunization history)

but UW say that even if the guy was vaccinated completely; if it has been more than 10 years since this vaccination then we should give immunoglobulin with dirty wounds .... This is opposite to what UPTODATE mentioned!


please guys help
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  #2  
Old 06-06-2011
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Arrow Always to refer to the CDC guidelines

UW is correct about this.

Whenever you have doubt or there's confusion about an infectious disease management guidelines check the CDC website, it's the most authentic and the USMLE question maker goes back to it when deciding correct answers.

There's a very useful table in the CDC website, here it is

When to give Tetanus immunoglobulin prophylaxis?-tetanus-table.jpg
click image to enlarge

Reference: http://wwwnc.cdc.gov/travel/yellowbo...etanus.htm#879
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  #3  
Old 06-06-2011
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hey bud, thanks for replying. UW is wrong about this according to the table!!! from the table, there is only ONE situation that we give TIG in, and that is: incomplete vaccination History + Dirty wound

While UW says: we also give TIG even if immun. history was complete but more than 10 years passed, and the wound is dirty
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  #4  
Old 06-06-2011
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Oh yes. You are right

Anyway, just follow that table
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Old 06-06-2011
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Doesnt tetanus require a booster after 10 years?? maybe uworld is referring to that
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Old 06-06-2011
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Quote:
Originally Posted by docnas View Post
Doesnt tetanus require a booster after 10 years?? maybe uworld is referring to that
We are not talking about the vaccine, we are talking about the TIG
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  #7  
Old 06-06-2011
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What i meant was if 10 years didnt get a booster so if dirty wound will need to treat with TIG
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  #8  
Old 06-07-2011
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A 34-year-old male is brought to the emergency room after falling onto a sharp pole while trying to scale a fence. He suffered a 7-cm-long laceration on the lateral aspect of his left thigh. Exploration of the wound reveals a 3-cm deep wound with small pieces of rust and dirt throughout. He is alert, cooperative, and hemodynamically stable. Distal pulses in the left leg are palpable and equal to the right leg. He is able to dorsiflex and plantarflex both feet and Babinski sign is downgoing bilaterally. He is unsure as to his tetanus immunization status. In addition to surgical debridement and closure of the wound, what is the most appropriate next step in management to prevent morbidity?

Answer Choices
A. No further management
B. Tetanus immune globulin administration
C. Tetanus toxoid administration
D. Tetanus toxoid and tetanus immune globulin administration
E. Tetanus-diphtheria (Td) immunization
Explanation
Option D (Tetanus toxoid and tetanus immune globulin administration) is correct. This is a patient has a contaminated wound and requires some form of tetanus prophylaxis. Because it is uncertain if he has had his three primary doses of Tetanus-diphtheria (Td) immunizations, both tetanus toxoid and tetanus immunoglobulin is given.

Option A (No further management) is incorrect. This would be appropriate management if this patient knew his immunization had included three primary administrations of tetanus and the last dose was less than 5 years ago.

Option B (Tetanus immune globulin administration) is incorrect. Tetanus immune globulin is rarely administered by itself. It is used in combination with toxoid for prophylaxis and is also used for treating active tetanus. In this case, it would not be administered solely.

Option C (Tetanus toxoid administration) is incorrect. Tetanus toxoid and diphtheria toxoid combined use is preferred to sole administration of tetanus toxoid.

Option E (Tetanus-diphtheria [Td] immunization) is incorrect. Tetanus-diphtheria (Td) immunization would be appropriate if this patient knew his immunization had included three primary administrations of tetanus and the last dose was more than 5 years ago.
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  #9  
Old 06-07-2011
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Quote:
Originally Posted by docoftheworld View Post
My understanding was that the ONLY case in which we use Tetanus Immunoglobulins is the case of BOTH (dirty wound + Incomplete/nonexistent immunization history)

but UW say that even if the guy was vaccinated completely; if it has been more than 10 years since this vaccination then we should give immunoglobulin with dirty wounds .... This is opposite to what UPTODATE mentioned!


please guys help
if No. of vaccinations (Unclear or <3)
so MX(Adult-type tetanus vaccine) if wound Clean, minor
if Tetanus-prone(dirty wound) then mx is (Adult-type tetanus vaccine plus tetanus immunoglobulin)


if no vaccine ≥3 previous booster >10 years
and Clean, minor MX is Adult-type tetanus vaccine
if (Tetanus-prone ) mx is Adult-type tetanus vaccine
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  #10  
Old 06-07-2011
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Hi miss patho,

the situation u have put is unequivocal, what we are asking about is:

if the history of immunization is COMPLETE and KNOWN, but MORE than 10 years have passed since booster, do we give TIG?

Now UW says yes (and they updated the question in end of may 2011!!! so perhaps its new recommendations) ... this important, CDC website says there is no need and UW says there is ... of course CDC is more important BUT ..... i am doubtful
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  #11  
Old 06-07-2011
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Quote:
Originally Posted by docoftheworld View Post
Hi miss patho,

the situation u have put is unequivocal, what we are asking about is:

if the history of immunization is COMPLETE and KNOWN, but MORE than 10 years have passed since booster, do we give TIG?

Now UW says yes (and they updated the question in end of may 2011!!! so perhaps its new recommendations) ... this important, CDC website says there is no need and UW says there is ... of course CDC is more important BUT ..... i am doubtful
u give only vaccine not TIG (wound dirty or clean )if more than 10 years last booster vaccine
so idont know about the new update in uw sorry
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  #12  
Old 06-07-2011
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guys, you who solved UW didnt you find it weird? anyone has input about this?
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  #13  
Old 08-25-2011
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Default tetanus

what is the recommendation for a man who has not received tetanus vaccination yet, and has a contamined wound?

what is the recommendation for a man who has not received tetanus vaccination yet without any recent injury?

What is the recommendation for those who received the vaccination 6 years ago and has a contamined wound? What in the case of a history of 12 years old vacc?
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  #14  
Old 08-25-2011
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Quote:
Originally Posted by aghammoud85 View Post
what is the recommendation for a man who has not received tetanus vaccination yet, and has a contamined wound?

what is the recommendation for a man who has not received tetanus vaccination yet without any recent injury?

What is the recommendation for those who received the vaccination 6 years ago and has a contaminated wound? What in the case of a history of 12 years old vacc?
1) give vaccine + Ig
2) after 10 year booster shot , and if never had vaccine -give now
3)>5 year and got contaminated wound- you give vaccine
>10 year -give vaccine and Ig
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  #15  
Old 08-25-2011
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Quote:
Originally Posted by aghammoud85 View Post
what is the recommendation for a man who has not received tetanus vaccination yet, and has a contamined wound?

what is the recommendation for a man who has not received tetanus vaccination yet without any recent injury?

What is the recommendation for those who received the vaccination 6 years ago and has a contaminated wound? What in the case of a history of 12 years old vacc?
1. Vaccine Td + Ig
2. Vaccine Td
3. Vaccine Td + Ig both cases
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  #16  
Old 09-06-2011
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Quote:
Originally Posted by docoftheworld View Post
guys, you who solved UW didnt you find it weird? anyone has input about this?
wow...i just reached that question in uworld...had to recheck my lecture notes...n then i searched the forum, ur question is the exact question i was thinking of posting...lol...
yes uworld seems wrong...!!! so did u send them any feedback or were able to check if there was any change in guidelines???
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  #17  
Old 09-06-2011
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Quote:
Originally Posted by us1us View Post
1. Vaccine Td + Ig
2. Vaccine Td
3. Vaccine Td + Ig both cases

hey, i have a confusion....
y r u guyz giving TIG in the 3rd category...?? CDC recommendations say that if a pt with contaminated wound has completed his immunization, he should be vaccinated if >5yrs have passed. No TIG.
n TIG only is given if pt hasnt completed his course of immunization or has unknown status n has contaminated wound.

This is what CDC says....link is

http://wwwnc.cdc.gov/travel/yellowbo...etanus.htm#879
n this is what uptodate n kaplan lecture notes say..

the confusion started when i had a question in uworld (q. i.d 3356, 376069) that coincides with ur explanation....can u post any reference??? any new guidelines that im not aware of?? which prove ur theory of giving tig to a pt with contaminated wound whose immunzation status is complete but >10 yrs have passed
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Old 09-07-2011
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U are right Aasiaafzal !

i have followed the cdc link. TIG be given to person who have incomplete vaccination history less than 3 doses ! So answer to both cases in 3rd q is Td only !
but i don t know why uworld mention in table that TIG be given ! May be they mean the same thing and just written extra so that it be given if less than 3 doses or incomplete vaccination history.

Anyways good link u have shared !
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  #19  
Old 09-07-2011
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Quote:
Originally Posted by us1us View Post
U are right Aasiaafzal !

i have followed the cdc link. TIG be given to person who have incomplete vaccination history less than 3 doses ! So answer to both cases in 3rd q is Td only !
but i don t know why uworld mention in table that TIG be given ! May be they mean the same thing and just written extra so that it be given if less than 3 doses or incomplete vaccination history.

Anyways good link u have shared !
yes i think uworld copied the previous recommendation table or sumthing, because their explanation is right, but table is showing conflicting data....initially i thought perhaps these r newer guidelines...i have sent feedback to uworld on that question...i dont know if they respond to feedbacks or not...lets c....
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  #20  
Old 09-08-2011
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o god..dats so confusing..wt to folow n wt nt to....do post the right answer coz i had the concept dat if unclear history of vaccination n dirty wound then immunoglobulin is given with vaccine
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Old 09-08-2011
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Quote:
Originally Posted by natashaqutab View Post
o god..dats so confusing..wt to folow n wt nt to....do post the right answer coz i had the concept dat if unclear history of vaccination n dirty wound then immunoglobulin is given with vaccine
yes it is sometimes confusing, but atleast in this scenario, follow only the info given on CDC page....its very accurate n up to date....infact they also have given the concept of use of Tdap rather than Td...! Also have a luk at that....
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Old 04-29-2013
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wow....atleast somewhat cleared regarding TIG

thanks for the post guys..i think uworld really messed up with TIG prophylaxis...

goodluck all
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