American Board of Family Medicine (ABFM) Practice Exam

For a patient with a tetanus-suspected wound and a Tdap booster received more than 5 years ago, what should be given next?

1. TT (tetanus toxoid)

2. Td (tetanus toxoid with reduced diphtheria)

3. TIG (tetanus immune globulin)

4. Tdap (tetanus toxoid with reduced diphtheria and acellular pertussis)

The correct answer is: Tdap (tetanus toxoid with reduced diphtheria and acellular pertussis)

In the case of a patient with a wound suspected of being contaminated with tetanus and who has received a Tdap booster more than 5 years ago, administering the Tdap vaccine again is the appropriate action. The Tdap vaccine provides protection against not only tetanus but also diphtheria and pertussis. For wounds that are clean and minor, the recommendation is to administer Td if the last booster was received more than 10 years ago. However, for wounds that are more serious or potentially contaminated, the guideline changes. Since the patient's last Tdap was more than 5 years ago, they should receive another dose of Tdap to ensure adequate protection against tetanus, especially given the nature of the wound. This is important as Tdap elicits a stronger immune response compared to Td and also addresses pertussis, which can be a consideration in certain clinical scenarios. Ultimately, the focus is on ensuring that the patient is fully vaccinated against tetanus, which is critical in managing injuries at risk for tetanus infection.