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What to do for unvaccinated child who gets bitten by indoor dog:

  • TIG + DTaP

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  • TIG only

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  • DTaP only

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Discussion Starter · #1 ·
<p>The standard treatment of puncture wounds in children in ER is to:</p>
<ol><li>Administer Tetanus Immunoglobulin (TIG)</li>
<li>Administer DTaP shot</li>
</ol><p> </p>
<p>I wonder.  What is the risk of someone with a puncture wound actually contracting tetanus?</p>
<p> </p>
<p>What are the risks of someone having adverse effects from taking TIG which have not been shown to be safe for children?</p>
<p>Look at the package insert: <a href="http://www.talecris-pi.info/inserts/hypertet.pdf" target="_blank">http://www.talecris-pi.info/inserts/hypertet.pdf</a></p>
<ol><li>Angiogenic edema</li>
<li>Nephrotic syndrome</li>
<li>Anaphylactic shock</li>
</ol><p>Also not mentioned is the fact that they may contract the following sorts of diseases from contamination of plasma, and the patient may not even know for a long time and may not even associate the condition with the TIG:</p>
<ol><li>Hepatitis C</li>
<li>Creutzfeldt-Jakob Disease (CJD)</li>
</ol><p> </p>
<p>Is there a numeric comparison comparing the outcomes of either side, those taking TIG and those not?  Sure the change of contracting tetanus is scary, but the risks of TIG seem to make it a wash, and you might as well chance it by hoping for the best.</p>
 

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Discussion Starter · #2 ·
<p>Then again, we are "forgiven" when we choose to treat and end up with a negative outcome (drug/vaccine side effects) but when we choose not to treat and things go awry, then we are judged to be negligent.</p>
 

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<p>While I do not know the statistics for children with adverse events associated with the TIG (nor where to get that info), I think one can only make this choice by asssessing the wound itself. I would never sy "dog bites" need the TIG. If my unvaxed toddler was bitten by an indoor dog, and the wound bled and I was meticulous about debriding and cleaning  - I would probably NOT do the TIG.</p>
 

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<p>I guess to some degree it would depend on the degree of the bite but my son has been bitten by my dogs (my son is not vaxed and my dogs are only vaxed for Rabies). Most of the bites rarely break the skin...more nips when he is aggravating them...but there have been some that have broken the skin a bit. Nothing I would consider a puncture wound though. I always do try to make wounds bleed a little if at all possible...and then I clean with hydrogen peroxide.</p>
<p> </p>
<p>The risks here you are trying to access are so minute ~ the risk of contracting tetanus, the risk of side effects from TIG and the risks of the vaccinations.</p>
<p> </p>
<p>I will say this ~ WHY would someone get TIG and the DTaP or even just the DTaP after the puncture wound? Why on Earth would you get a vaccination after possible exposure when the vaccine is not effective for at least 14 days? It would do nothing for that particular injury.</p>
<p> </p>
<p>At any rate ~ while I know tetanus is serious/dangerous ~ the risk of contracting it via a puncture wound is very very slim so it really is just not on my radar screen of something I obsess over. I mean we are talking 50-100 people each year in the States and of those cases nearly 90% are in adults over the age of 40 years of age (33% are in persons over 65 years of age)...so really, we are talking VERY MINIMAL risks here...so minute I am thinking you just need to go with your gut!</p>
 
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