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Medicine for the Outdoors
Medicine for the Outdoors

Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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Tetanus Shot After a Bee Sting


Regarding a bee sting, a reader asks, "Do I need to get a tetanus shot after a sting? What if I had a shot 5 years ago? Do I need another?"

Everyone should be properly immunized against tetanus, which is caused by the bacterium Clostridium tetani. In the U.S., diphteria-tetanus-pertussis (DTaP) vaccine is given as an intramuscular injection at ages 2, 4, 6, and 8 months, followed by a booster at age 4 to 6 years, usually before entry into school. These shots provide immunity from tetanus, as well as from diphtheria and pertussis [whooping cough]) for about 10 years. The first booster shot is usually given at age 11 or 12 years in the form of Tdap vaccine. Thereafter, Td (tetanus and diphtheria) vaccine is usually recommended at 10 year intervals. However, given a resurgence of whooping cough seen in adults, the recommendation may change to continue immunizing against pertussis with the Tdap vaccine in perpetuity. Following immunization against tetanus, immunity in any individual is unknown, and can be determined by measuring antibodies in blood. This is particularly important in elders, in whom the immune response to vaccination may be suppressed by a general lower level of the immune system associated with age.

The current practice is to take a booster shot (Td) if one sustains a "dirty" wound, deep puncture, serious burn, significant crush injury, etc. and has not had a tetanus shot in the preceding 5 years. If a wound is felt to be at particularly high risk for infection with C. tetani (e.g., if it is a very deep puncture or contaminated by soil or animal feces), it may also be recommended to have an injection of tetanus immune globulin as well as a tetanus booster immunization. Whether or not to administer tetanus immune globulin is generally a judgment call by the treating health care professional. The immune globulin contains actual antibodies against the bacteria, so that the recipient carries protective antibodies against the bacteria until his or her body has a chance to manufacture its own antibodies in response to the Td booster shot.

A bee sting in general does not pose a large risk for tetanus infection. Although deep punctures of other varieties deposit bacteria into the wound(s), where C. tetani can thrive in the absence of oxygen, a bee sting puncture isn't that deep. The stinger might transfer bacteria from the skin surface, wherein lies the greatest risk. So, my recommendation is that if a person has been immunized within the past 5 years, it is unnecessary to get a Td booster immunization. If it has been more than 5 years but less than 10 years since the last tetanus shot, a Td booster is indicated. If it has been more than 10 years since the last tetanus shot, both a Td booster and tetanus immune globulin are indicated, if you go by the book.

Remember to write down the dates of all immunizations in a place where you can readily find the record. Many of us have had extra tetanus shots because we were unable to record the date of our prior immunization. Also, remember that it is essential to clean all wounds if possible promptly with soap and water, followed by a fresh water rinse, in order to remove as much dirt and bacteria as possible. This may be difficult with a tiny puncture wound like a bee sting, but do the best you can, particularly with open cuts and scrapes that have been contaminated with dirt or other grime.

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photo courtesy of ruppweb.dyndns.org/ttfc/ttfc.htm
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Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.

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