Tetanus Prophylaxis

Tetanus is a life-threatening neuromuscular disease caused by the contamination of wounds with clostridium tetani. Both tetanus toxoid (Td) (typically mixed with diphtheria toxoid [DT]) and tetanus immunoglobulin (TIG) are used in trauma. The trauma immunization schedule recommended by the United States Center for Disease Control is shown in Table 31.4.

Table 31.2. Bacteria found in bites by species. Animal Bacteria

Siberian tiger Pasteurella multocida

Bergeyella zoohelcum Pasteurella meningitis Veillonella parvula

Pasteurella multocida, canis, dagmatis, stomatis Staphylococcus aureus Staphylcoccus intermedius Alpha hemolytic streptococci Capnocytophaga canimorsus Anaerobic bacteria Pseudomonas fluorescens Prevotella heparinolytica Corybacterium spp. Bergeyella zoohelcum Bacteroides spp. Veillonella parvule Pasteurella multocida Veillonella parvule Eikenella corrodens Human immunodeficiency virus Alpha-hemolytic streptococci Haemophilus species Anerobic bacteria Bacteroides spp. Staphylococcus epidermidis Bacillus subtillus Diptheroids

Hemolytic streptococcus Escherichia coli Streptococcus milleri

Source: Data from Goldstein (22), Armstrong et al. (23), Rayan et al. (24), and Brook (25).

Contraindications to immunizations in trauma include a documented history of a severe allergic reaction leading to acute respiratory distress, or collapse with a prior immunization. Side effects include local reactions with erythema and induration, exaggerated local reactions, and, uncommonly, fever and systemic reactions (21).

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