The current recommendation is that if a patient attends with a tetanus
prone wound, they should receive the immunoglobulin even if they have
had the recommended "full" schedule.
If your patient had attended at the time of injury with a gardening
injury then they would hopefully have been given the Humotet
immunoglobulin. My current practice is to do this in the presence of
"high-risk" wounds even if they are fully immunised. We recently had a
case of tetanus at North Bristol, and thus are rather paranoid about it
at the moment!
Simon Odum
Associate Specialist
Emergency Medicine
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Ray McGlone
Sent: 21 May 2004 23:34
To: [log in to unmask]
Subject: Tetanus
I was wondering what people were doing on the ground regarding tetanus
immunisation. We hadn't had a tetanus case in our area for over 20 years
until one case last year and now another one this year. The last case
was a
35 yr old who had had 5 boosters last one being as a teenager (full
course),
the person developed tetanus about two weeks after a thorn injury whilst
gardening. The person did not attend A&E at the time of the injury.
But on the current advice (enclosed) she would not have been offered a
tetanus booster if she had attended A&E. I must admit that I still offer
a
booster if the wound is "tetanus prone" if they have not had a booster
within 10 years. In the study below adequate circulating levels of
antitoxin
were acheived within 4 days of the booster.
What do other people do?
Ray McGlone
A&E Lancaster
Authors
Simonsen O. Kjeldsen K. Heron I.
Title
Immunity against tetanus and effect of revaccination 25-30 years after
primary vaccination.
Source
Lancet. 2(8414):1240-2, 1984 Dec 1.
Local Messages
Held at BMA Library
Abstract
Fall off in tetanus immunity and the effect of late revaccination were
investigated in a randomly selected group of Danes aged 25-30. Routine
reinforcing doses of tetanus toxoid are not customary in Denmark except
at
injury and when there are certain occupational risks. 11% of the total
group
of 418 had antitoxin titres below that required for protection (ie, less
than 0.01 IU/ml, determined by neutralisation technique). In those who
had
received only primary vaccination an exponential fall off in immunity
was
seen, and 25-30 years after primary vaccination, 28% had serum antitoxin
concentrations below the level of protection. Up to 30 years after
primary
vaccination, one reinforcing dose of tetanus toxoid adsorbed by
aluminium
hydroxide was sufficient to induce protective titres of antitoxin. There
were no serious side-effects and it was concluded that routine
reinforcing
doses of tetanus toxoid should be given before the age of 20 in Denmark
and
other countries where primary vaccination is given in the first years of
life.
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