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Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 29531
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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I have a few questions about the tentenus shot

Resolved Question:

I have a few questions about the tetanus shot

Submitted: 1 year ago.
Category: Health
Expert:  Dr. Arun Phophalia replied 1 year ago.
Greetings.

What is your question about your tetanus shot?

Thank you.

Dr. Arun
Customer: replied 1 year ago.

Since you are a surgeon and sports medicine specialist, I am wondering if this is an appropriate question for you...


 

Expert:  Dr. Arun Phophalia replied 1 year ago.
Hello,

As a surgeon, I deal a lot with all kind of infections and prevention.

I hope to answer it up to your utmost satisfaction. If I think that it is beyond my knowledge and experience, I would opt out and other expert may take over the question.
Customer: replied 1 year ago.

Ok. I had a tetanus booster 9 years ago (March '04). I slipped this afternoon on outside steps that had rusty metal. I cut my arm - I don't know what I cut it on but maybe the rusty metal. It wasn't a real deep cut but deeper than skin and bled some.


 


1) Should I get a tetanus booster now? (Does the benefit outweigh the risk?)


2) If so, should I do that at the ER tonight or at the after-hours tomorrow at my doctor's office (or at CVS - I believe their pharmacy offers)


3) I asked my parents if I received the series of tetanus shots as a child. They can't find my records but they assume I did. I guess my doctor assumed I did when I got the booster 9 years ago. Can they look that up in a database? If I never had those, then I should get that instead of the booster, right?


4) Was reading online. What shot is it - DTAP, TDAP, or DT?


5) Is an accurate tetanus titer available with check results instead?

Expert:  Dr. Arun Phophalia replied 1 year ago.
Hello,

Yes, you should get a booster. Benefit outweighs the risk and a booster is required after 2-5 years (especially after the contaminated injury).

Ideally an urgent care clinic or ER would be the best option. But if you can get it within 12 hours, you may not go to ER tonight (looking at the hassle and waiting period).

You should get a booster regardless of your tetanus vaccination previously.

These are combination of vaccine: these are given in childhood.
DT; diphtheria, tetanus.
DTaP vaccine is highly effective for the prevention of diphtheria, tetanus, and pertussis
Td or Tdap. Vaccine. (Tetanus-Diphtheria or. Tetanus-Diphtheria-Pertussis).

The accurate titer is not available, so there is no blood work for it.

Please feel free for your follow up questions.

I would be happy to assist you further, if you need any more information.

 

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Customer: replied 1 year ago.
I'll pay more for this since I'm asking more questions.

1. Do you have a reference for 2 to 5 years? Everything I read says 10 years, and my doctor's office had told me a couple months ago 10 years. But both sources said they may recommend earlier if there's a puncture wound or dirty wound.

2. 12 hours from the cut, or from now? My doctor's office is open in 14 hours from now.

3. I thought I read that without a vaccination history, a series of 3 shots is required?

4. What's the name of the booster?

5. This mentions a titer test but doesn't say much: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6002a1.htm

6. The CDC article mentions precaution in moderate to severe acute illness. Just curious - is the concern with a health reaction to the shot or that the shot will not be as effective?

7. Any precautions with chronic illnesses?
Expert:  Dr. Arun Phophalia replied 1 year ago.
1. Do you have a reference for 2 to 5 years? Everything I read says 10 years, and my doctor's office had told me a couple months ago 10 years. But both sources said they may recommend earlier if there's a puncture wound or dirty wound.

This is one of the most authentic resource with the cross references. There are not strict guidelines but doctors would take a call according to the wound contamination and previous vaccination history:

http://emedicine.medscape.com/article/229594-treatment#aw2aab6b6b6


2. 12 hours from the cut, or from now? My doctor's office is open in 14 hours from now.

Twelve hours is from the wound / injury. Clean it thoroughly meanwhile and go to ER ideally.



3. I thought I read that without a vaccination history, a series of 3 shots is required?

If you do not have any vaccination three doses would be given.


4. What's the name of the booster?
It is called as tetanus vaccine.
See the reference;

http://emedicine.medscape.com/article/229594-medication#8


5. This mentions a titer test but doesn't say much: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6002a1.htm

The titer test is not clinically important for the decision making as vaccine is recommended in all cases which are contaminated (non surgical wounds).


6. The CDC article mentions precaution in moderate to severe acute illness. Just curious - is the concern with a health reaction to the shot or that the shot will not be as effective?
If you have fever or flu, caution is done as immunity is low and vaccine may not be very effective.


7. Any precautions with chronic illnesses?
Just for 3 days after vaccination one may report fever or redness at the site in chronic illness like diabetes, cancer or patient who have kidney or other organ transplant.
Customer: replied 1 year ago.

1. In the reference you gave me, I'm seeing 10 years. The only thing related to 5 is: "A tetanus toxoid–containing vaccine MAY be recommended as part of standard wound management in adults aged 19 years and older if it has been at least 5 years since last receipt of Td; if a tetanus booster is indicated, Tdap is preferred to Td for wound management in adults aged 19 years and older who have not received Tdap previously


So, it sounds like it depends on what the person received? I don't know if the ER will have access to my doctor's office records.


 


3. As I said, I had a booster 9 years ago, but I don't know if I received the initial 3 shots. In that case, wouldn't I need the initial 3 shots?? Can they find this in a database?


 


4. What booster do I need - Tdap or Td, etc.?


 


5. So no concern about serious reactions of the shot due to acute or chronic illnesses?


 


I am going to pay for this, but I'm a little frustrated that it doesn't seem this is your area of expertise.

Expert:  Dr. Arun Phophalia replied 1 year ago.
1) The 5 years would be relevant in your case. ER would give you pure tetanus shot usually.

2) The database may not be available at ER.

3) Your primary care physician would decide going through the database so initially it would be tetanus at ER and later your GP would decide about the exact vaccination.

4) Reaction to vaccine has extremely low incidence, so not worry on that count in case of chronic illness.

Believe me, I deal with this kind of issues as a general surgeon. I worked in traumatology (post doctoral fellowship) in Paris, France. A consensus is to give vaccination in your case. There is no doubt about it.
Customer: replied 1 year ago.


For question #3 - My GP is not the same doctor that would have given the initial shots as a baby....So is the database you're referring to him going through a main database - do those exist? If so, I guess he concluded that I received the initial 3 shots when he gave the booster 9 years ago.


 


For question #4 - Is the reaction to vaccine extremely low in the case of acute illnesses also?

Expert:  Dr. Arun Phophalia replied 1 year ago.
Yes the reaction incidence is very low generally. The GP would be able to access your previous medical history of childhood. Usually they exist and are accessible.
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 29531
Experience: MBBS, MS (General Surgery), Fellowship in Sports Medicine
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