Tetanus and trauma: a review and recommendations.
BACKGROUND
This review covers the pathogenesis and treatment of the disease along with the reexamination of the current recommendations for prophylaxis against tetanus in the United States. Although tetanus is still a major problem worldwide, the incidence in North America has become almost negligible because of the highly effective primary immunization program. Recently, there have been no deaths reported attributable to tetanus in the United States in trauma patients who had received the primary childhood immunization. However, tetanus immunization and prophylaxis in the acute injury setting is frequently misused and misunderstood.


METHODS
A review of the literature regarding tetanus.


RESULTS
After review, the authors recommend tetanus toxoid in adults only if it has been more than 10 years since their last immunization. There is no urgency for the administration of tetanus toxoid in the acute setting, as it provides protection against the next injury and not the current injury. Tetanus-diphtheria toxoid is not required unless there are plans for the injured patient to travel to diphtheria-prone countries in the future, as the incidence of diphtheria is negligible in the United States.


CONCLUSIONS
The review of reported cases of tetanus demonstrates that it is not possible to clinically determine which wounds are tetanus prone, as tetanus can occur after minor, seemingly innocuous injuries, yet is rare after severely contaminated wounds. Tetanus immunoglobulin should be reserved for patients with wounds who had never received primary immunization against tetanus.
Rhee
Peter
P
Navy Trauma Training Center at Los Angeles County Medical Center, California 90033, USA. prhee@nshs-sd.med.navy.mil
Nunley
Mary K
MK
Demetriades
Demetrios
D
Velmahos
George
G
Doucet
Jay J
JJ
D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D049673:History, 20th Century; D006801:Humans; D007115:Immunization Schedule; D007223:Infant; D017410:Practice Guidelines as Topic; D013742:Tetanus / Q000209:etiology* / Q000266:history / Q000503:physiopathology / Q000517:prevention & control*; D013745:Tetanus Toxoid / Q000008:administration & dosage; D014481:United States; D014946:Wound Infection / Q000150:complications* / Q000266:history / Q000503:physiopathology / Q000517:prevention & control*
D013745:Tetanus Toxoid