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19-01-2012 | Podiatry | Article

Tetanus immunity check recommended for chronic wound patients


Free abstract

MedWire News: More effort should be made to ensure that patients with chronic leg wounds have adequate protection against tetanus, say UK researchers on finding that around half of patients do not have up to date vaccination against the infection.

"Tetanus prophylaxis is not just an important consideration when evaluating acute traumatic wounds, but should be considered a routine protocol when managing chronic wounds," recommend Aravindan Rangaraj and co-workers from the University of Cardiff.

They suggest that a check on tetanus vaccination status should be included in the guidelines for patients with chronic wounds, especially those with diabetes who are at increased susceptibility for the infection.

The team audited the tetanus immunization status of 100 patients attending chronic wound clinics in three Welsh hospitals over 5 days.

The patients, 51 of whom were male, were aged a median of 70 years and had wounds lasting between 1 and 480 months. About half (n=48) had diabetes. The majority of wounds were in the leg or foot, with venous ulcers (n=35) and diabetic foot ulcers (n=22) the most common injury. Fifteen percent of patients had undergone wound biopsy.

When asked, 48% of patients were unsure about their tetanus vaccination status, while 22% believed their tetanus vaccinations were up to date, and 30% said they did not have immunity.

When general practitioner (GP) records were examined, just 33% of patients were up to date with their tetanus vaccinations, defined as completion of five vaccine doses in childhood or a booster vaccination within the past 10 years.

In all, 43% of patients did not have up to date tetanus vaccinations, while 13% had no record of immunization in their GP records, 10% were unable to give GP contact details, and GPs were not contactable for 1% of patients.

"Currently, tetanus prophylaxis is given based on the vaccination history of the patient but as identified… this can prove to be unreliable," Rangaraj et al conclude in the International Wound Journal.

"With the burden of chronic wound and ageing population set to increase, levels of protection amplify the risk of tetanus faced by those suffering from chronic wounds. Strict caution should be taken in those patients who were born before the national childhood vaccination programme, implemented in 1961."

By Lynda Williams

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