On tetanus convo. I’ve run into a few times, a kid w no prior vaccinations w a lac that I’ve gotten mom to agree to tetanus (🤷🏼♀️ But 🥳). We don’t carry Dtap in the ED, should I just give Tdap? UpToDate says Td or Dtap for under 7 if I remember right. I’ve never gotten an answer to that. And if I can vaccinate a kid w some sneaky extra vaccines I’m all in. Also is there utility to a single vaccine in this situation or do I need to get them to also agree for followup boosters to make it worth it.
The CDC now recommends tetanus for all wounds if last vaccination was more than 5 years ago.
https://www.cdc.gov/tetanus/clinicians.html
If the last dose of a tetanus toxoid-containing vaccine was received 5 or more years earlier, then administer a booster dose of an age-appropriate tetanus toxoid-containing vaccine.
I am not sure whether I agree with this segment about giving Tdap in the ED because of the added pertussis protection. Here's the ACIP/CDC recommendations: https://www.cdc.gov/mmwr/volumes/67/rr/rr6702a1.htm
No Additional Doses of Tdap for the General Population
...Clinical trials support that a second dose of Tdap is safe and immunogenic at a 5- or 10-year interval (184–188). Immunogenicity studies show that diphtheria and tetanus antibody levels persisted for five to 10 years after receipt of Tdap (186,188,262,263,297–301). However, antipertussis antibodies decline rapidly after the first year, suggesting that protection wanes, which would likely limit the impact of a second dose of Tdap on the overall burden of pertussis in the United States (186,188,262,263,297–301). Antibody decay and, therefore, clinical protection following additional doses of Tdap are likely similar to what is observed following the first dose of Tdap.
David - excellent points. We focused more on the tetanus piece of this but, we need to give pertussis a bit more attention. We'll get Isaac back on to discuss all of this. Thanks!
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Heather H. - February 13, 2021 5:05 AM
On tetanus convo. I’ve run into a few times, a kid w no prior vaccinations w a lac that I’ve gotten mom to agree to tetanus (🤷🏼♀️ But 🥳). We don’t carry Dtap in the ED, should I just give Tdap? UpToDate says Td or Dtap for under 7 if I remember right. I’ve never gotten an answer to that. And if I can vaccinate a kid w some sneaky extra vaccines I’m all in. Also is there utility to a single vaccine in this situation or do I need to get them to also agree for followup boosters to make it worth it.
Catherine M. - February 17, 2021 9:01 AM
The CDC now recommends tetanus for all wounds if last vaccination was more than 5 years ago.
https://www.cdc.gov/tetanus/clinicians.html
If the last dose of a tetanus toxoid-containing vaccine was received 5 or more years earlier, then administer a booster dose of an age-appropriate tetanus toxoid-containing vaccine.
David W. - February 17, 2021 11:04 AM
I am not sure whether I agree with this segment about giving Tdap in the ED because of the added pertussis protection. Here's the ACIP/CDC recommendations: https://www.cdc.gov/mmwr/volumes/67/rr/rr6702a1.htm
No Additional Doses of Tdap for the General Population
...Clinical trials support that a second dose of Tdap is safe and immunogenic at a 5- or 10-year interval (184–188). Immunogenicity studies show that diphtheria and tetanus antibody levels persisted for five to 10 years after receipt of Tdap (186,188,262,263,297–301). However, antipertussis antibodies decline rapidly after the first year, suggesting that protection wanes, which would likely limit the impact of a second dose of Tdap on the overall burden of pertussis in the United States (186,188,262,263,297–301). Antibody decay and, therefore, clinical protection following additional doses of Tdap are likely similar to what is observed following the first dose of Tdap.
Anand S., M.D. - February 18, 2021 8:16 AM
David - excellent points. We focused more on the tetanus piece of this but, we need to give pertussis a bit more attention. We'll get Isaac back on to discuss all of this. Thanks!