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Tetanus and trauma: a review and recommendations
Peter Rhee1, Mary K Nunley, Demetrios Demetriades
1Navy Trauma Training Center at Los Angeles County Medical Center, California 90033, USA. prhee@nshs-sd.med.navy.mil
The Journal of Trauma
|May 28, 2005
Summary
Tetanus immunization in the US is effective, but often misunderstood. Recommendations suggest tetanus toxoid for adults every 10 years, with no immediate need for acute injuries.
Area of Science:
- Immunology
- Infectious Diseases
- Public Health
Background:
- Tetanus remains a global health concern, though its incidence in North America is low due to widespread childhood immunization.
- Misconceptions and misuse of tetanus prophylaxis are common in acute injury settings in the United States.
Observation:
- A review of literature on tetanus pathogenesis, treatment, and prophylaxis was conducted.
- Analysis focused on current recommendations for tetanus prophylaxis in the US, particularly in trauma patients.
Findings:
- Tetanus toxoid is recommended for adults only if their last immunization was over 10 years prior.
- Tetanus toxoid provides protection for future injuries, not current ones; immediate administration is not urgent.
- Tetanus-diphtheria toxoid is generally unnecessary in the US due to low diphtheria incidence, unless travel to endemic areas is planned.
Implications:
- Clinical assessment of wound tetanus risk is unreliable; tetanus can follow minor or major injuries.
- Tetanus immunoglobulin is reserved for individuals without a history of primary tetanus immunization.
- Updated guidelines are needed to address the misuse and misunderstanding of tetanus prophylaxis in acute care.