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In April 2018, updated interim guidance was issued in response to changes in available IV immunoglobulin products in the NHS. Based on testing carried out by NIBSC of 7 other IV immunoglobulin products to determine if they have similar levels of tetanus antibody, it was recommended that they may be used as alternatives to previously tested products for suspected clinical cases of tetanus.
PHE has recently become aware of a severe shortage of IM-TIG and Subgam available in the NHS, which are recommended for prophylaxis of tetanus-prone wounds. Furthermore, the alternative HNIG products that are approved for use by NHS England are also in limited supply. As a consequence, PHE has urgently reviewed the existing evidence and data to prioritise the use of TIG /HNIG for susceptible individuals who have sustained high risk injuries, and are at greatest risk. Guidance for classifying tetanus-prone injuries has also been revised to assist correct usage