178 - Tetanus

of the clinical presentation of the disease. The diagnosis can be suspected but not confirmed in the emergency depart­ ment (ED). In addition to recognizing the clinical presentation of tetanus, EPs play a vital role in the prevention of the disease. Primary pediatric vaccination and regular decennial booster vaccination are the mainstays of disease prevention and sever­ ity modulation. Herd immunity does not occur with tetanus. Therefore, only people who receive the vaccination benefit from immunization. In the United States, the prevalence of tetanus immunity decreases by age, after 40 years of age. At 40 years of age, 80% of the population is immune to tetanus. By the age of 80 years, only 30% of the population remains immune. This decrease is most striking in women and Mexican Americans. Only 36% of persons age 65 years old or older report receiving tetanus vaccination in the past 10 years. Most cases of tetanus and fatalities resulting from tetanus are in patients who either have never been vaccinated or have not had a booster in the past 10 years. EPs have the opportunity to provide booster vaccination at times of minor to severe injury and skin infection. In light of pertussis epidemics, • Puncture wounds pose the highest risk for tetanus. Tetanus also occurs following clean, minor wounds, abscesses, and cellulitis. • Keep current the tetanus immunization status of patients with any injury, even minor, clean wounds. • Give tetanus immune globulin to patients with wounds, other than clean, simple wounds, who have never completed a primary tetanus immunization series. • Tetanus is a clinical diagnosis. Begin treatment when the diagnosis is suspected in any patient with unexplained rigidity. • Tetanus treatment consists of tetanus immune globulin, antibiotics, and local wound care. KEY POINTS