Tetanus Prophylaxis in Emergency Departments and Urgent Care Centers
By, Stanley Grogg, DO, ACOP, Professor Emeritus, Oklahoma State University-Center for Health Sciences
Christine F. Giesa, DO, FACOEP-D, President-elect, American College of Osteopathic Emergency Physicians
Introduction:
During 2015, state health departments reported 20,762 cases of pertussis to CDC. This represents a 37% decrease compared to 32,971 cases reported during 2014. Age-incidence trends observed during 2015 were like those in 2014 and 2013. CDC again observed increased rates in adolescents 13 through 15 years of age, as well as in 16-year olds. (1)
ACIP Recommendations:
To continue decreasing the incidence of pertussis in the USA, the Advisory Committee on Immunization Practices (ACIP) recommends a dose of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) Tdap to be administer to persons aged 7 years and older who are not fully immunized with DTaP vaccine. Since 2005, the ACIP has recommended a Tdap vaccine booster dose for all adolescents aged 11 through 18 years (preferred at 11 through 12 years) and for those adults aged 19 through 64 years who have not yet received a dose. In October 2010, despite the lack of an approved Tdap vaccine for adults aged 65 years and older, ACIP recommended that unvaccinated adults aged 65 years and older be vaccinated with Tdap if in close contact with an infant, and that other adults aged 65 years and older may receive Tdap. In July 2011, the Food and Drug Administration (FDA) approved expanding the age indication for Boostrix (GlaxoSmithKline Biologicals, Rixensart, Belgium) to aged 65 years and older. In February 2012, ACIP recommended Tdap for all adults aged 65 years and older. (2,3,4)
Hospital Emergency Departments and Urgent Care Centers:
In accordance with ACIP recommendations, whenever tetanus toxoid is indicated for wound management, hospital emergency departments and urgent care centers should administer Tdap vaccine instead of tetanus and diphtheria (Td) toxoids or tetanus toxoid (TT) to all patients 10 years of age and older, including pregnant women who have not had a previous dose of Tdap or have not received a Tdap during the present pregnancy. Children 7 through 9 years of age should receive Tdap vaccine if they have an incomplete DTaP series as described above.
Since only one dose of Tdap vaccine is currently indicated, it is important to assess a patient's immunization history and determine if a dose of Tdap had previously been given. If immunization records are not available, assume that the patient has not received a prior dose of Tdap.
Conclusions:
Protect the patients under your care from serious diseases, such as pertussis and tetanus by adhering to the ACIP use of Tdap instead of Td for wound management in the emergency or urgent care departments. Do not miss opportunities to keep patients under your care immunized against vaccine preventable diseases.
Resources:
Two State Departments of Health, Michigan and Florida, have protocols available for review. (5, 6)
References:
1.
CDC reported incidence of Pertussis 2015: https://www.cdc.gov/pertussis/outbreaks/trends.html (accessed 11/3/2017)
2.
ACIP recommendations for Tdap vaccine schedule for catch-up for ages 7-18 years of age (2017): https://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-child-combined-schedule.pdf ((accessed 11/3/2017)
3.
ACIP recommendations for Tdap/Td Vaccines (2017): https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/tdap-td.html (accessed 11/3/2017)
4.
ACIP recommendations for use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine in adults aged 65 years and older (2017): https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6125a4.htm. (accessed 11/3/2017)
5.
State of Michigan, Department of Community Health for use of Tdap in ERs and Urgent Care Centers: http://www.michigan.gov/documents/mdch/060512_Letter_Tdap_ERs_388633_7.pdf, (accessed 11/3/2017)
6.
State of Florida Health Department use of Tdap in ED and Urgent care centers: http://www.floridahealth.gov/programs-and-services/immunization/publications/_documents/tdap-ers.pdf. (accessed 11/3/2017)