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Performance of a bedside test for tetanus immunity: results of a cross-sectional study among three EDs in the Netherlands in 2012–2013
  1. N AT van der Maas1,
  2. R Donken1,2,
  3. M J M te Wierik1,3,
  4. C M Swaan1,
  5. S J M Hahne1,
  6. H E de Melker1
  1. 1Centre for Infectious Disease Control—National Institute for Public Health and the Environment, The Netherlands
  2. 2Department of Pathology, VU University Medical Centre, Amsterdam, The Netherlands
  3. 3Public Health Service, Region Utrecht, The Netherlands
  1. Correspondence to N A T van der Maas, P. O. Box 1, Bilthoven 3720BA, The Netherlands; Nicoline.van.der.maas{at}


Introduction 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.

Conclusion 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.

  • infectious diseases, bacterial
  • musculo-skeletal, soft tissue infection
  • research, epidemiology
  • wounds, infection

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  • Contributors NATvdM, RD and HEdeM set up the study design. RD collected all data. RD and NATvdM analysed the data. NATvdM wrote the first draft of the manuscript. All authors critically revised the manuscript and agreed on the final version.

  • Competing interests None declared.

  • Ethics approval Medical Ethics Committee, VCMO, situated at Nieuwegein, the Netherlands (NL39940.100.12).

  • Provenance and peer review Not commissioned; externally peer reviewed.