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PEP underutilized in California tetanus patients
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There were 21 cases of tetanus reported in California from January 2008 to March 2014, and among those, 16 reported acute injuries before illness onset. Only two of those patients received appropriate post-exposure prophylaxis before the onset of tetanus symptoms, according to an MMWR report.
“Even minor wounds or abrasions can result in tetanus, highlighting the importance of ensuring that patients are up to date for [tetanus toxoid-containing vaccinations (TT)],” investigators with the California Department of Public Health wrote. “[The Advisory Committee on Immunization Practices] recommends that persons with unknown or incomplete histories receive TT as part of routine wound management; patients with wounds that are neither clean nor minor should receive [tetanus immune globulin (TIG)] in addition to TT.”
All patients with tetanus were hospitalized. Nineteen were admitted to the ICU, and nine required mechanical ventilation. Seven patients were at increased risk for tetanus, four due to diabetes and three who were injection drug users. Twelve patients had reported their TT history: three didn’t recall receiving any doses, and nine recalled receiving at least one dose. Among those who had received a dose, six received it 10 to 50 years before their illness.
Among the patients who reported acute injuries, seven had puncture wounds, four had abrasions, three had linear lacerations, one had a compound fracture, and one had an animal bite. Only nine patients sought medical care, and two received the ACIP-recommended post-exposure prophylaxis (PEP). Of the remaining seven patients, five had punctures or contaminated wounds and unknown TT history, and should have received TT and TIG.
All 21 patients were treated with TIG, six within 1 day of symptom onset, eight within 4 days and six within 9 days. One patient was treated more than 2 weeks after symptom onset. Five cases were fatal.
“Although rates of tetanus have declined, sporadic cases continue to occur, particularly in adults who are not up-to-date with TT,” the researchers wrote. “Health care providers should assess the tetanus vaccination status of their patients during routine visits. All providers who provide care for patients with wounds should have protocols for tetanus PEP and ensure that appropriate PEP is provided for such patients.” – by Emily Shafer
Disclosure: The researchers report no relevant financial disclosures.
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