Chinese expert consensus on tetanus prophylaxis in major trauma (2026 Edition)

Tetanus is an acute infectious disease caused by Clostridium tetani, which enters the body through contaminated wounds, proliferates under anaerobic conditions, and produces neurotoxin. Patients with major trauma are at a markedly increased risk of tetanus owing to extensive tissue injury, heavy wound contamination, and trauma-associated impairment of immune function. Existing guidelines and consensus statements on tetanus prophylaxis largely address general open wounds and provide little specific guidance for patients with major trauma, particularly those undergoing emergency life-saving surgery through expedited care pathways or admitted to the intensive care unit. To standardize tetanus prophylaxis in the management of major trauma, the writing committee convened Chinese experts in emergency medicine, trauma surgery, critical care medicine, and immunology to develop this expert consensus based on the best available evidence and current clinical practice in China. The consensus covers the fundamental principles of tetanus prophylaxis in major trauma, damage-control debridement, assessment of immune status, active and passive immunization strategies, management of special injury types, prophylaxis in immunocompromised patients, response to mass-casualty incidents, and preventive strategies under resource-limited conditions, and it aims to provide practical guidance for tetanus prophylaxis during the clinical management of major trauma.