About TetanusCheck & UK tetanus guidance

Last clinical review: 10 May 2026

Next scheduled review: 10 November 2026

Content is checked against UKHSA and Green Book updates at least every six months, and immediately when material guidance changes.

TetanusCheck is a free educational decision-support aid for UK healthcare professionals managing potentially tetanus-prone wounds. Given a small set of patient and wound inputs, it produces a recommendation for:

• Whether a tetanus-containing booster (e.g. Revaxis / Td-IPV) is indicated.
• Whether tetanus immunoglobulin (HTIG / HNIG) is indicated and at what dose (250 IU vs 500 IU).
• Wound-care and follow-up considerations.

All calculation runs locally in the browser. No patient data is stored or transmitted.

The UK routine tetanus vaccine schedule is a five-dose course delivered as part of combined vaccines, summarised in Immunisation against infectious disease (the Green Book), Chapter 30. Completion of all five doses at the correct intervals is considered to give satisfactory long-term protection for most clinical situations.

After five appropriately spaced doses, further routine boosters are not required. For tetanus-prone wounds, UKHSA still recommends a reinforcing dose if more than 10 years have elapsed since the last dose, and additional tetanus immunoglobulin for high-risk wounds — see the next section.

UKHSA classifies wounds into three groups: clean, tetanus-prone, and high-risk tetanus-prone. The category drives whether a tetanus booster, tetanus immunoglobulin, or both are indicated alongside thorough wound toilet.

For tetanus-prone wounds, a reinforcing dose of tetanus-containing vaccine is given if the primary course is incomplete, status unknown, or the last dose was > 10 years ago. For high-risk tetanus-prone wounds, tetanus immunoglobulin is added regardless of immunisation status. Always combine prophylaxis with appropriate wound debridement.

Revaxis is the UK low-dose combined tetanus, diphtheria and inactivated polio vaccine for people aged 10 years and over. It is used for the teenage booster, routine adult boosters, catch-up courses, and post-exposure prophylaxis after a tetanus-prone wound when a dose is indicated.

• Dose: 0.5 mL by intramuscular injection (deltoid preferred).
• Age: 10 years and over.
• Schedule: single dose for boosting; three doses at least 4 weeks apart for an incomplete or unknown primary course.
• Cautions: defer in acute febrile illness; anaphylaxis to a previous dose or component is a contraindication.

Full prescribing information is on the BNF tetanus vaccine summary.

Tetanus immunoglobulin provides immediate passive immunity for high-risk tetanus-prone wounds and for treatment of suspected tetanus. In the UK, specific tetanus immunoglobulin (TIG / HTIG) is the preferred product; when unavailable, UKHSA and JCVI accept human normal immunoglobulin (HNIG) — products including Subgam, Cuvitru and Gammanorm — as an alternative.

• Standard prophylactic dose: 250 IU IM.
• Double to 500 IU IM if any of: more than 24 hours since injury, heavy contamination, following burns, or in adults > 90 kg with extensive wounds.
• Treatment of clinical tetanus: higher doses are used — discuss urgently with infectious diseases / microbiology and notify UKHSA.
• Administration: separate limb from any concurrent tetanus-containing vaccine.

Tetanus immunoglobulin is in addition to, not a replacement for, a tetanus-containing vaccine when the primary course is incomplete, unknown, or the last dose was > 10 years ago.