Thank you for your inquiry.
There is no standard protocol to deal with the issue you described. However, large local reactions usually are not considered a contraindication for readministration. What you can do to begin with is check your patient’s tetanus antibody titer. If the patient has protective levels, they would not need a vaccination. If, however, they do need a vaccination, and you are concerned about a large local, you could divide the immunization into five steps as follows: 0.1 cc day one; 0.2 cc two days later; 0.2 cc two days after the second dose.
This will give you, additively, a total immunizing dose, and you would have a chance to assess for any local reaction after immunization which might slow the progression of your dose.
Thank you again for your inquiry and we hope this response is helpful to you.
Phil Lieberman, M.D.