Tetanus

Question 1

Tetanus-containing vaccines are (live/inactivated) vaccines

Answer 1

Inactivated

Made from cell-free purified toxin of Clostridium tetani absorbed on aluminium hydroxide or aluminium phosphate to improve immunogenicity

Question 2

How many doses of tetanus-containing vaccines are in the immunisation schedule in the UK?

Answer 2

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

Question 3

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?

Answer 3

Parenteral drug misusers

Question 4

The primary course of vaccinations against tetanus consists of 3 doses of the vaccine. How many weeks apart should the doses be given?

Answer 4

4 weeks intervals between doses

Use the diphtheria with tetanus, pertussis, hepatitis B, poliomyelitis and haemophilus influenzae type b vaccine

Question 5

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?

Answer 5

Primary course of 3 doses:

1. 8 weeks
2. 12 weeks
3. 16 weeks

Boosters:

4. 3 years and 4 months
5. 13-18 years

Question 6

Which vaccine is used in the primary course of immunisation against tetanus (first 3 doses)?

Answer 6

Infanrix hexa: diphtheria with tetanus, pertussis, hepatitis B, poliomyelitis and haemophilus influenzae type b vaccine

Question 7

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

Answer 7

3 doses of the diphtheria with tetanus and poliomyelitis vaccine

at 1 month intervals

Question 8

Which vaccine is used as a booster for tetanus immunisation?

Answer 8

Boostrix-IPV or Repevax: diphtheria with tetanus, pertussis and poliomyelitis

Given twice after primary course

1. 3 years and 4 months
2. 13-18 years

Question 9

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?

Answer 9

1 year

Question 10

What is the criteria for a traveller to receive a booster dose for tetanus? (2)

Answer 10

Last tetanus booster > 10 years ago
AND
Travelling to areas where medical attention may not be accessible

Question 11

Is tetanus a notifiable disease?

Answer 11

YES

Question 12

What is used for the treatment of a wound that is considered high-risk for tetanus or confirmed tetanus?

Answer 12

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.

Question 13

Give 5 examples of tetanus-prone wounds

Answer 13

1. Compound fractures
2. Certain animal bites and scratches
3. Puncture-type injuries acquired in contaminated environments (likely to contain tetanus spores)
4. Wounds or burns with systemic sepsis
5. Wounds containing foreign bodies

NOT a comprehensive list

Question 14

Give 3 examples of high-risk tetanus-prone wounds

Answer 14

1. Wounds or burns that show extensive devitalised tissue
2. Wounds or burns that require surgical intervention that is delayed > 6 hours
3. Wounds that are heavily contaminated with material likely to contain tetanus spores (soil or manure)

Question 15

When doing a risk-assessment of tetanus-prone wounds how many doses of a tetanus-containing vaccine are considered an adequate priming course?

Answer 15

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

Question 16

When do you need to give an immediate booster dose of a tetanus-containing vaccine (and nothing else)?

Answer 16

Patient has a tetanus-prone or high-risk tetanus-prone wound, plus one of the following:

1. Individuals with an adequate priming course of tetanus vaccine (3 doses) but last dose of a tetanus-containing vaccine was > 10 years ago
   OR
2. Children aged 5-10 years who have received an adequate priming course (3 doses) but NO booster

Question 17

Which wounds should be given a single dose of IV tetanus immunoglobulin (or normal immunoglobulin)?

Answer 17

High-risk tetanus-prone wounds

Question 18

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)?

Answer 18

Immediate booster dose
AND
Tetanus immunoglobulin (or normal immunoglobulin) IV

Question 19

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?

Answer 19

Thoroughly clean wound and surgical debridement of devitalised tissue

Question 20

Is a tetanus-containing vaccine given routinely to pregnant women?

Answer 20

YES

From week 16 of pregnancy as part of the maternal pertussis programme

Diphtheria with tetanus, pertussis and poliomyelitis vaccine

Question 21

If a pregnant woman gets a tetanus-prone wound, can they be given a tetanus-containing vaccine?

Answer 21

YES

Question 22

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?

Answer 22

Now