[Prevention of tetanus in the hospital first-aid service]

It has been well known that every wound can become infected by C. tetani. Up to now, the antitetanic prophylaxis and/or therapy were based on empirical criteria, not capable of guaranteeing protection for the wounded. In fact: a) the type of wound and the environment in which the trauma occurred cannot exclude the possibility of infection owing to the ubiquity of the tetanic spore; b) the anamnestic data are often not reliable; c) repeated doses of tetanus anatoxin administered according to different vaccination schedules could give unexpected results; d) the protective effects of a vaccination declines in time in a manner different from one individual to another; e) there are subjects who do not acquire protection even after a vaccination treatment given according to schedule (low responders); f) the excessive number of recall doses of anatoxin, in some subjects can exhibit hypersensitivity side effects. Therefore, for each wounded patient a rational intervention of antitetanus prophylaxis is necessary, based on the rapid determination of antitetanus antibody level. A correlation has been documented between titre of antibody determined by the passive haemoagglutination test (HA) and neutralization test. The HA assay can be a useful tool (because of its easy application and rapidity of the results) in discriminating in wounded patients what type of rational therapeutic approach must be performed.