Tetanus vaccination in the accident and emergency department

While tetanus is a rare disease in industrialized countries, this infectious disease is still responsible for up to 1,000,000 deaths per year in the developing world. In Germany, the introduction of a country-wide vaccination program (STIKO) has led to a decrease in the frequency of tetanus infection from 115 cases per year in the 1960s to fewer than 15 cases per year in the years from 1990 to 2000. In spite of all the treatment now available, tetanus infection still has a lethal outcome in up to 40% of cases. The Robert-Koch Institute recommends active or passive vaccination depending on the wound classification and the patient's current vaccination status. Since when patients have multiple trauma the emphasis while they are being treated for shock is on stabilisation and diagnosis, there is a real risk of underestimating the size and the level of contamination of existing wounds. Since it is not possible to ascertain the patient's vaccination status in most cases, we recommend simultaneous immunization of polytraumatized patients with skin lesions using Tetanol-Tetagam early in the course of the diagnostic procedures while the patients are still in the emergency room.