title: Pertussis vaccination in adult trauma patients: Are we missing an opportunity?
abstract: BACKGROUND
  Trauma centers commonly administer tetanus prophylaxis to patients sustaining open wounds. In the United States, there are different vaccinations available for adult administration: tetanus/diphtheria toxoid (Td) or tetanus/reduced diphtheria and acellular pertussis (Tdap). The importance of the Tdap preparation lies in its vaccination against pertussis while providing tetanus immunity. Vaccination against pertussis is paramount for disease prevention. In recent decades, there has been a steady rise in pertussis cases. This epidemic increase caused the Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) to recommend the routine use of Tdap when tetanus prophylaxis is indicated.
  
  
  OBJECTIVE
  The aim of this study was to gather data on which formulation of tetanus vaccination is currently being given to adult trauma patients. We hoped to increase awareness of the expanded recommendations for vaccination against pertussis when tetanus prophylaxis is indicated, thus providing patients with protection against pertussis.
  
  
  METHODS
  An institutional review board exempt, web-based, nationwide survey was sent to adult trauma center coordinators that could be located via an Internet search. Questions included trauma center level designation, number of trauma evaluations per year, zip code, hospital description (university, university affiliated, or community), and which vaccination is given for adults <65 years and those ≥65. At the conclusion of the survey, hyperlinks to the CDC ACIP recommendations were provided as an educational tool.
  
  
  RESULTS
  A total of 718 emails were successfully sent and 439 (61%) completed surveys were returned. Level 4/5 centers had the highest compliance rates for those patients between ages 18 and 64 (93%), followed by level 2/3 (87%), and then level 1 centers (57%). Among all centers, the use of Tdap was lower in the ≥65 year group. Level 2 trauma centers were the most compliant with this age group (61%) followed by level 4/5 (57%) and level 1 (43%) centers.
  
  
  CONCLUSIONS
  With the increase in pertussis cases, vaccination remains crucial to prevention. The CDC recommendations for Tdap have existed for adults <65 years since 2005 and those ≥65 years since 2012. However, many adult trauma centers do not adhere to the current CDC ACIP guidelines for tetanus/pertussis vaccination. In particular, level 1 trauma centers and those classified as university hospitals have the lowest rate of compliance with these recommendations. Through this survey, trauma centers were educated on current recommendations. Increased vaccination of trauma patients with Tdap should improve protection against this virulent pathogen.
authors.affiliation: Division of Trauma & Critical Care, Temple University Hospital, Philadelphia, PA; Division of Trauma, Burn, Surgical Critical Care, Brigham and Women's Hospital, Boston, MA. Electronic address: byorkgitis@partners.org.
authors.forename: Brian K
authors.initials: BK
authors.lastname: Yorkgitis
authors.affiliation: Temple University School of Medicine, Philadelphia, PA.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Timoney
authors.affiliation: Division of Trauma, Burn, Surgical Critical Care, Brigham and Women's Hospital, Boston, MA.
authors.forename: Ali
authors.initials: A
authors.lastname: Salim
authors.affiliation: Temple University School of Medicine, Philadelphia, PA.
authors.forename: Polly van den
authors.initials: Pv
authors.lastname: Berg
authors.affiliation: Division of Trauma & Critical Care, Temple University Hospital, Philadelphia, PA.
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Goldberg
authors.affiliation: Division of Trauma & Critical Care, Temple University Hospital, Philadelphia, PA.
authors.forename: Abhijit
authors.initials: A
authors.lastname: Pathak
authors.affiliation: Division of Trauma & Critical Care, Temple University Hospital, Philadelphia, PA.
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Rappold
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D057566:Self Report; D013742:Tetanus / Q000209:etiology / Q000517:prevention & control*; D013745:Tetanus Toxoid; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014481:United States; D014611:Vaccination / Q000706:statistics & numerical data*; D014917:Whooping Cough / Q000517:prevention & control*; D014947:Wounds and Injuries / Q000150:complications / Q000628:therapy*; D055815:Young Adult
chemical_list: D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines; D013745:Tetanus Toxoid