UncleEJ Posted March 4, 2015 Share Posted March 4, 2015 My 7yo DS just informed me that he cut the palm of his hand on a nail today while playing outside. The cut is super small, almost imperceptible. It looks like a scratch he could have gotten anywhere. He said it bleed a tiny bit. He had the first 4 DTaP shots as a baby. The last one was 11/2008. He never had the fifth one that was supposed to happen between ages 4-6. Should I worry? Also, we have an appointment in two weeks to get him caught up. All three are a bit behind. Quote Link to comment Share on other sites More sharing options...
kiana Posted March 4, 2015 Share Posted March 4, 2015 It's been 7 years, and it was an outdoor nail -- I wouldn't worry, but I would take him to an urgent care clinic or similar tomorrow for the shot. Tetanus is one of the ones where the treatment really sucks if they DO get it. 2 Quote Link to comment Share on other sites More sharing options...
UncleEJ Posted March 4, 2015 Author Share Posted March 4, 2015 It's been 7 years, and it was an outdoor nail -- I wouldn't worry, but I would take him to an urgent care clinic or similar tomorrow for the shot. Tetanus is one of the ones where the treatment really sucks if they DO get it. That is what I was thinking. I was hoping it wasn't a rush to the ER at 8:30pm situation. Quote Link to comment Share on other sites More sharing options...
ashfern Posted March 4, 2015 Share Posted March 4, 2015 You want the tetanus immune globulin (TIG) not the vaccine for a possible exposure. 2 Quote Link to comment Share on other sites More sharing options...
G5052 Posted March 4, 2015 Share Posted March 4, 2015 It's been 7 years, and it was an outdoor nail -- I wouldn't worry, but I would take him to an urgent care clinic or similar tomorrow for the shot. Tetanus is one of the ones where the treatment really sucks if they DO get it. Yes, tomorrow is fine. I wouldn't delay though. Wash the cut well with soapy water though. I've told this story before here but some years ago our internist at the time told me that he had a tetanus case. To their knowledge, there was nothing more than a few scratches from working in their garden that led to it. Both the treatment and outcome really shook him up as a doctor. He told this by way of convincing me to get my tetanus shot on time. It lives in the soil, and you can get it from any outdoor cut. 1 Quote Link to comment Share on other sites More sharing options...
allyphoe Posted March 4, 2015 Share Posted March 4, 2015 As an adult, I scratched myself on a rusty nail. (Nail hadn't been exposed to soil, not a puncture wound, so a low-risk situation.) It had been more than 10 years since my last tetanus booster. I called the health department (they have a vaccine clinic) and they held the office open until I could get there so I could get a booster that same day. Quote Link to comment Share on other sites More sharing options...
LMV Posted March 4, 2015 Share Posted March 4, 2015 You want the tetanus immune globulin (TIG) not the vaccine for a possible exposure. The OP stated that her child had received four prior doses of DTaP as a baby. There is no indication for TIG unless the OP's child is also HIV+, or has another significant immune deficiency state. ACIP/CDC guidelines would recommend that this child receive Tdap as they are not sufficiently immunized for pertussis. Some physicians and or parents may be a little uncomfortable with that because none of the Tdap preparations have FDA approval below age ten. In such cases, Td can be substituted but parents need to understand that the child may not be fully protected against pertussis and should get Tdap booster as a young adolescent. Given the current pertussis situation in the US, I believe that this is a situation where the benefits of off label prescribing outweigh the risks, however, I do fully disclose to parents of children in this scenario that it would be off label usage, explain the rationale of that, and let them make the final decision. If they opt for Td then I document that Tdap was recommended based on CDC/ACIP recommendations and that it was stressed to them that their child likely is not fully protected against pertussis. The child receives Td and goes on their way (and hopefully gets Tdap later). If they agree with Tdap I document that Tdap was used based on ACIP/CDC guidelines and that parents are aware of (and signed an acknowledgment form to this effect because our hospital requires this) the off label usage but agree that the benefits outweigh the risks for their child. 1 Quote Link to comment Share on other sites More sharing options...
Lolly Posted March 4, 2015 Share Posted March 4, 2015 A small, almost imperceptible scratch? Has had the first 4 shots. I wouldn't worry about it. Go in for the scheduled visit. (Df, myself, and DD are all allergic to the vaccine. This would be what our doctors would advice for such a scratch.) Quote Link to comment Share on other sites More sharing options...
LMV Posted March 4, 2015 Share Posted March 4, 2015 A small, almost imperceptible scratch? Has had the first 4 shots. I wouldn't worry about it. Go in for the scheduled visit. (Df, myself, and DD are all allergic to the vaccine. This would be what our doctors would advice for such a scratch.) The reality is that tetanus can happen from small imperceptible scratches and some patients have trouble recalling any wound. I acknowledge that every one needs to make the decisions that they feel are best for themselves and their children, however, withholding immunization from a child with a possible exposure and no prior problems with vaccine components seems needlessly risky from my vantage point, as both a physician and as a mom. 2 Quote Link to comment Share on other sites More sharing options...
Tsuga Posted March 4, 2015 Share Posted March 4, 2015 My 7yo DS just informed me that he cut the palm of his hand on a nail today while playing outside. The cut is super small, almost imperceptible. It looks like a scratch he could have gotten anywhere. He said it bleed a tiny bit. He had the first 4 DTaP shots as a baby. The last one was 11/2008. He never had the fifth one that was supposed to happen between ages 4-6. Should I worry? Also, we have an appointment in two weeks to get him caught up. All three are a bit behind. Don't worry--just get the shot. :) This is a low-probability, high-impact thing. Will he probably get tetanus if you don't get the shot? No. Would it suck incredibly badly if he did? Yes, and there can be permanent consequence. 1 Quote Link to comment Share on other sites More sharing options...
LMV Posted March 4, 2015 Share Posted March 4, 2015 Don't worry--just get the shot. :) This is a low-probability, high-impact thing. Will he probably get tetanus if you don't get the shot? No. Would it suck incredibly badly if he did? Yes, and there can be permanent consequence. Mortality rates for tetanus in the US are around 10% (even with prompt treatment and an ICU level of care). 1 Quote Link to comment Share on other sites More sharing options...
Lolly Posted March 4, 2015 Share Posted March 4, 2015 Mortality rates for tetanus in the US are around 10% (even with prompt treatment and an ICU level of care). And 10% of an incredibly low number is an even lower number. Binip is quite correct in response. As far as my response goes, it is based on those odds, and yes it is for my family. The fact that the original series was completed as an infant, and the child in question is only a year past the recommended booster makes the chances of contracting tetanus from a scratch exceptionally small. Slim enough that I, personally, would not worry about rushing to the doctor. Binip is probably more mainstream in her "get the shot" advice. Odds are there is no harm done in getting it. Then again, in my family, those odds are probably higher of something going wrong than getting the disease. That does color my perception a bit. Only responding because your post seems a bit scare tacticy, and I just hate it when people do that. 1 Quote Link to comment Share on other sites More sharing options...
UncleEJ Posted March 4, 2015 Author Share Posted March 4, 2015 Well, I got him an appointment to get the shot tomorrow. I get that the risk is small, but it's not one I want to take. Thank you for all the advice! 1 Quote Link to comment Share on other sites More sharing options...
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