PT  - JOURNAL ARTICLE
AU  - N AT van der Maas
AU  - R Donken
AU  - M J M te Wierik
AU  - C M Swaan
AU  - S J M Hahne
AU  - H E de Melker
TI  - Performance of a bedside test for tetanus immunity: results of a cross-sectional study among three EDs in the Netherlands in 2012–2013
AID  - 10.1136/emermed-2015-205412
DP  - 2016 Nov 01
TA  - Emergency Medicine Journal
PG  - 763--768
VI  - 33
IP  - 11
4099  - http://emj.bmj.com/content/33/11/763.short
4100  - http://emj.bmj.com/content/33/11/763.full
SO  - Emerg Med J2016 Nov 01; 33
AB  - 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.