**4. Tetanus and Rabies**

In addition to causing a localized infection, dog bites may also transmit pathogens that can cause a systemic illness. The most commonly considered sequelae are tetanus and rabies [4, 9, 24, 25].

#### **4.1 Tetanus**

The management of tetanus prophylaxis in dog bites is based upon the immunization status of the affected patient (see **Table 3**). If the child has received less than 3 doses of the tetanus toxoid-containing vaccine or the vaccination status is unknown, human tetanus immunoglobulin should be administered as well as a dose of tetanus toxoid-containing vaccine [24]. For those that have completed a 3-dose series, determine if/when the last dose was administered and if they have undergone any booster shots. If the last tetanus vaccine was 5 or more years ago, it is recommended that they receive a booster dose of the age-appropriate tetanus vaccine [24].
