I couldn't agree more Nick (and Chris Kirke), this is a public health issue
and we should steer clear of it. Yes, we do provide active tetanus
immunisation (albeit only after initial childhood immunisation) but this is
largely for historical reasons and is clearly opportunistic. Besides active
"booster" immunisation probably does confer some benefit against the
material accident, unlike initial immunisation. To introduce diphtheria
vaccination however would require specific patient counselling and consent
for a non-emergency situation - that's clearly not our job!
All this may become irrelevant however. I heard a rumour last year that
patients only need five tetanus vaccinations to confer lifelong immunity; in
other words, most people will be fully immune by age 15, and should
therefore never require booster immunisation. However I never heard nor
could find confirmation from DoH, from PHLS or from BAEM about this. Can
anyone out there enlighten me?
Adrian Fogarty
----- Original Message -----
From: Nick Jenkins
Subject: Re: Replacement of tetanus booster for adults
> It begs the question "should we be providing active immunisation in A&E?".
> Clearly we need to passively immunise with the immunoglobulin if the
patient
> isn't immunised and has a tetanus prone wound - we just take the
opportunity
> of actively immunising with toxoid if they need it. Strictly speaking
> that's a primary care duty - until now I've been happy to provide it to
> avoid inconveniencing the patient who, after all, doesn't understand our
> lines of responsibilty and would feel messed about if I sent them to their
> GP to update their tetanus - probably wouldn't go anyway. This will make
me
> reconsider - my job's nothing to do with immunisation against diptheria -
> where does it stop? - do we end up entering into the MMR debate??
> Nick Jenkins
> A&E Consultant, Abergavenny
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