Tetanus Flashcards
Tetanus-containing vaccines are (live/inactivated) vaccines
Inactivated
Made from cell-free purified toxin of Clostridium tetani absorbed on aluminium hydroxide or aluminium phosphate to improve immunogenicity
How many doses of tetanus-containing vaccines are in the immunisation schedule in the UK?
5 doses
Primary coursse: 3 doses of the diphtheria with tetanus, pertussis, hepatitis B, poliomyelitis and haemophilus influenzae type b vaccine (Infanrix hexa) - age 8 weeks, 12 weeks, 16 weeks
+
Single booster of the diphtheria with tetanus, pertussis and poliomyelitis vaccine (Boostrix-IPV or Repevax) - age 3 years and 4 months
+
Single booster of diphtheria with tetanus and poliomyelitis vaccine (Revaxis) - age 13-18 years
Which patient demographic are at greater risk of tetanus infection and every opportunity should be taken to ensure that they are fully vaccinated against tetanus?
Parenteral drug misusers
The primary course of vaccinations against tetanus consists of 3 doses of the vaccine. How many weeks apart should the doses be given?
4 weeks intervals between doses
Use the diphtheria with tetanus, pertussis, hepatitis B, poliomyelitis and haemophilus influenzae type b vaccine
In the routine immunisation schedule at what age are the 3 primary courses of the tetanus vaccine given to children and when are the two booster vaccines given?
Primary course of 3 doses:
- 8 weeks
- 12 weeks
- 16 weeks
Boosters:
- 3 years and 4 months
- 13-18 years
Which vaccine is used in the primary course of immunisation against tetanus (first 3 doses)?
Infanrix hexa: diphtheria with tetanus, pertussis, hepatitis B, poliomyelitis and haemophilus influenzae type b vaccine
If an individual aged 10 years and over has not been previously immunised against tetanus what will their primary course of vaccinations include?
- Include how many doses and which vaccine
3 doses of the diphtheria with tetanus and poliomyelitis vaccine
at 1 month intervals
Which vaccine is used as a booster for tetanus immunisation?
Boostrix-IPV or Repevax: diphtheria with tetanus, pertussis and poliomyelitis
Given twice after primary course
- 3 years and 4 months
- 13-18 years
If there was a delay in the primary course of the tetanus vaccination. What is the minimum time required between the 3rd dose of the primary course and the first booster dose?
1 year
What is the criteria for a traveller to receive a booster dose for tetanus? (2)
Last tetanus booster > 10 years ago
AND
Travelling to areas where medical attention may not be accessible
Is tetanus a notifiable disease?
YES
What is used for the treatment of a wound that is considered high-risk for tetanus or confirmed tetanus?
IV normal immunoglobulin [unlicensed] is recommended
IV tetanus immunoglobulin is no longer available in the UK and the volume of IM tetanus immunoglobulin required to reach a therapeutic dose would be too large in most individuals.
Give 5 examples of tetanus-prone wounds
- Compound fractures
- Certain animal bites and scratches
- Puncture-type injuries acquired in contaminated environments (likely to contain tetanus spores)
- Wounds or burns with systemic sepsis
- Wounds containing foreign bodies
NOT a comprehensive list
Give 3 examples of high-risk tetanus-prone wounds
- Wounds or burns that show extensive devitalised tissue
- Wounds or burns that require surgical intervention that is delayed > 6 hours
- Wounds that are heavily contaminated with material likely to contain tetanus spores (soil or manure)
When doing a risk-assessment of tetanus-prone wounds how many doses of a tetanus-containing vaccine are considered an adequate priming course?
3 doses
** Primary course is 3 doses
**Fully immunised is considered 3 doses of primary course + 2 boosters
** adequate priming course when assessing tetanus risk of a wound is considered 3 doses
When do you need to give an immediate booster dose of a tetanus-containing vaccine (and nothing else)?
Patient has a tetanus-prone or high-risk tetanus-prone wound, plus one of the following:
- Individuals with an adequate priming course of tetanus vaccine (3 doses) but last dose of a tetanus-containing vaccine was > 10 years ago
OR - Children aged 5-10 years who have received an adequate priming course (3 doses) but NO booster
Which wounds should be given a single dose of IV tetanus immunoglobulin (or normal immunoglobulin)?
High-risk tetanus-prone wounds
What is the treatment of a tetanus-prone or high-risk tetanus-prone wound in an individual who did not receive an adequate priming course of tetanus vaccine (3 doses)?
Immediate booster dose AND Tetanus immunoglobulin (or normal immunoglobulin) IV
For a high-risk tetanus prone wound, apart from a booster dose of the tetanus vaccine and tetanus (or normal) immunoglobulin, what is an essential part of the prevention of tetanus infection?
Thoroughly clean wound and surgical debridement of devitalised tissue
Is a tetanus-containing vaccine given routinely to pregnant women?
YES
From week 16 of pregnancy as part of the maternal pertussis programme
Diphtheria with tetanus, pertussis and poliomyelitis vaccine
If a pregnant woman gets a tetanus-prone wound, can they be given a tetanus-containing vaccine?
YES
If a pregnant woman has not previously been immunised against tetanus, should you complete the primary course (3 doses) now or wait until after she delivers?
Now
