B. K. Yorkgitis1,2, G. Timoney2, P. Van Den Berg2, A. Goldberg2, A. Pathak2, A. Salim1, J. Rappold2 1Brigham And Women’s Hospital,Trauma, Burn, Surgical Critical Care,Boston, MA, USA 2Temple University,Division Of Trauma,Philadelpha, PA, USA
Introduction: Trauma centers commonly administer tetanus prophylaxis to patients sustaining wounds. In the U.S., there are currently two different vaccinations available for adult administration: tetanus/diphtheria toxoid (Td) or tetanus/reduced diphtheria and acellular pertussis (Tdap). The importance of Tdap lies in its vaccination against pertussis while providing tetanus immunity.
Since the 1980’s there has been a steady rise in pertussis cases, from the low in 1976 of 1,010 to a high of 48,277 in 2012.1 This epidemic rise caused the Centers for Disease Control (CDC) Advisory Committee on Immunization Practices (ACIP) to recommend the routine use of Tdap when tetanus prophylaxis is indicated. Vaccination against pertussis is paramount for prevention.
Methods: An institutional review board exempt, web based national survey was emailed to adult trauma center coordinators who's address could be located via an internet search. Questions included level designation, number of trauma evaluations annually, zip code, hospital description (university, university affiliated, community), and which preparation is given for adults <65 years and those over. The aim of this study was to gather data on which vaccination is currently being given to trauma patients. At the conclusion of the survey, hyperlinks to the CDC ACIP recommendations were provided as an educational tool.
Results: A total of 718 emails were successfully sent and 439 (61.1%) completed surveys were returned. Level 4/5 centers had the highest compliance rates for those patients between ages 18-65 (93%), followed by level 2/3 (86.9%), and last level 1 (56.9%). Among all centers, the use of Tdap was lower in the >65 years group. Level 2/3 trauma centers were the most compliant with this age group (60.6%) then level 4/5 (57.4%) and lastly level 1 (40.3%).
Conclusion: With the rise in pertussis cases, vaccination remains crucial to prevention. The CDC recommendations for Tdap have existed for adults <65 years since 2005 and those over 65 years since 2012.2 Yet many adult trauma centers do not adhere to the current ACIP guidelines. In particular, Level 1 trauma centers have the lowest rate of compliance. Through this survey, centers were educated on current recommendations. Increased vaccination of trauma patients with Tdap should improve protection against this virulent pathogen and result in a decreased incidence.
1. Center for Disease Control. (2014). Pertussis (Whooping Cough). Retrieved from http://www.cdc.gov/pertussis/surv-reporting.html
2. Updated Recommendation for Use of Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis (Tdap) Vaccine in Adults 65 Years and Older – Advisory Committee on Immunization Practices (ACIP), 2012. MMWR. 2012;61(25):468-70.
