by The Importance of the Tetanus Vaccination
In case you’ve missed this little gem last month:
Summary: unvaccinated 6 yr old Oregon boy sustained lac to the forehead and his hipster parent cleaned and sutured the lac at home. Boy got tetanus (surprise, surprise) and spent several weeks in the PICU fighting for his life. After a million dollars of medical care, parents again refused to give tetanus vaccination
Tetanus Schedule
Reminder: DTap and Tdap have coverage for diptheria, pertussis and tetanus
Td (recommended in adults >65yrs not in contact with young children) with only protection against tetanus
and diptheria (where the Immunizations advisory committee recommends Tdap for everyone) -When taking history for a patient, keep this in mind:
What if they have never had a tetanus shot?
-The Tetanus toxoid does not provide immediate antibody projection, which is why the tetanus immunoglobulin (in tetanus vaccines) are given simultaneously with the tetanus toxoid in unvaccinated individuals
-Those who have never completed tetanus immunization need to complete the series:
first TWO shots (Tdap) given four weeks apart
third shot is given about six to 12 months after the second shot after this series, they continue with the booster shots every 10 yrs
**keep this in mind when writing for follow up appointments upon discharge
When should we really be giving tetanus shots?
-Tetanus bacilli likes to live in soil so any dirty wound with contamination of dirt, animal feces, or manure are the highest risk -Minor & Clean wounds are okay within 10 years of last booster
-Deep & Dirty wounds (wounds contaminated with dirt, feces, soil, or saliva; puncture wounds; avulsions; wounds resulting from missiles, crushing, burns, or frostbite) need to receive a booster if the last vaccination was greater than 5 years ago
*pregnant women must receive booster with each pregnancy even if immunized or if previous pregnancy was in the last 12 months
-usually given during 27-36th weeks gestation -Tetanus prone wounds include:
*when discussing IVDU with those asking for detox/overdose, ask about last tetanus, they are at a very high risk!!
Is the ED giving too many tetanus boosters?
Pretty controversial for me to write, huh?
-One study, notes that the ED has improved the overall prophylactic vaccination and decrease in instances of tetanus
-Another notes, that patient’s immunization recollection is unreliable and out of 99 immunizations in the ED about 35 of them had documentation of recent immunization at primary care office. This study recommended giving the PCP a call prior to giving the booster.
-Obviously in our shop with our population, it is more realistic that we are giving the immunization as the majority of the patients do not have a PCP, but it definitely is food for thought.
Don’t want to give the tetanus? Anti-Vaxx patient? Here’s the alternative:
References:
- https://www.mayoclinic.org/diseases-conditions/tetanus/symptoms-causes/syc-20351625
- https://www.annemergmed.com/article/S0196-0644(03)01132-6/fulltext
- https://www.uptodate.com/contents/tetanus-diphtheria-toxoid-vaccination-in-adults?search=tetanus&source=search_ result&selectedTitle=2~150&usage_type=default&di
- https://lifeinthefastlane.com/tropical-medicine/tropical-medicine-vaccines-a-z/tetanus-vaccine/
- http://www.immunize.org/catg.d/p4220.pdf
- https://emj.bmj.com/content/22/8/609.2
