Performance of a bedside test for tetanus immunity: results of a cross-sectional study among three EDs in the Netherlands in 2012-2013.
BACKGROUND
Despite sustained high vaccination coverage and a national guideline by the Health Council (HC-guideline) on tetanus postexposure prophylaxis (T-PEP), tetanus sporadically occurs in the Netherlands. This study aims to assess the added value of a bedside test for tetanus immunity (Tetanos Quick Stick (TQS); Ingen BioSciences Group, France), in the context of routine T-PEP in two adult cohorts: those born before introduction of tetanus toxoid vaccination in the National Immunization Programme (NIP) in 1957 (pre-NIP-cohort; n=196) and those born after (NIP-cohort; n=405).


METHODS
Adults included at the time of visiting one of three participating EDs received T-PEP as per routine recommendations. Subsequently, a nurse performed the TQS and filled in a questionnaire. We compared the indication for T-PEP based on TQS results with those based on the HC-guideline and with actually administration of T-PEP, stratified by cohort.


RESULTS
Among the pre-NIP and NIP-cohort, 16% and 9%, respectively, received T-PEP, while this was not indicated based on the HC-guideline. Furthermore, 8% and 7%, respectively, did not get T-PEP, although it was indicated by the guideline. Comparing the indication derived from the HC-guideline with TQS result found that 22% (pre-NIP-cohort) and 8% (NIP-cohort) were not eligible for T-PEP according to the HC-guideline but had a negative TQS. Conversely, 36% (pre-NIP-cohort) and 73% (NIP-cohort) were eligible for T-PEP according to the HC-guideline but had positive TQS, indicating sufficient tetanus protection.


CONCLUSIONS
Use of the TQS would allow better targeting of T-PEP. Furthermore, stricter adherence to the HC-guideline can prevent overimmunisation and decrease the risk of tetanus.
Centre for Infectious Disease Control-National Institute for Public Health and the Environment, The Netherlands.
N At
NA
van der Maas
Centre for Infectious Disease Control-National Institute for Public Health and the Environment, The Netherlands.|Department of Pathology, VU University Medical Centre, Amsterdam, The Netherlands.
R
R
Donken
Centre for Infectious Disease Control-National Institute for Public Health and the Environment, The Netherlands.|Public Health Service, Region Utrecht, The Netherlands.
M J M
MJ
Te Wierik
Centre for Infectious Disease Control-National Institute for Public Health and the Environment, The Netherlands.
C M
CM
Swaan
Centre for Infectious Disease Control-National Institute for Public Health and the Environment, The Netherlands.
S J M
SJ
Hahne
Centre for Infectious Disease Control-National Institute for Public Health and the Environment, The Netherlands.
H E
HE
de Melker
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005260:Female; D006801:Humans; D017589:Immunization Programs / Q000592:standards / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D000067716:Point-of-Care Testing; D011795:Surveys and Questionnaires; D013742:Tetanus / Q000175:diagnosis* / Q000276:immunology*
infectious diseases, bacterial; musculo-skeletal, soft tissue infection; research, epidemiology; wounds, infection