van der Maas N At, Donken R, Te Wierik M J M, Swaan C M, Hahne S J M, de Melker H E
Centre for Infectious Disease Control-National Institute for Public Health and the Environment, The Netherlands.
Department of Pathology, VU University Medical Centre, Amsterdam, The Netherlands.
Emerg Med J. 2016 Nov;33(11):763-768. doi: 10.1136/emermed-2015-205412. Epub 2016 Sep 8.
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).
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.
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.
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.
尽管荷兰的破伤风疫苗接种覆盖率持续保持在较高水平，且卫生委员会也出台了关于破伤风暴露后预防（T-PEP）的国家指南，但破伤风仍时有发生。本研究旨在评估破伤风免疫床边检测（破伤风快速检测棒（TQS）；法国英根生物科学集团）在两个成年队列的常规T-PEP中的附加价值：一组是1957年国家免疫规划（NIP）引入破伤风类毒素疫苗之前出生的人群（NIP前队列；n = 196），另一组是之后出生的人群（NIP队列；n = 405）。
在三家参与研究的急诊科之一就诊时纳入的成年人按照常规建议接受T-PEP。随后，一名护士进行TQS检测并填写问卷。我们将基于TQS结果的T-PEP指征与基于卫生委员会指南的指征以及实际给予T-PEP的情况进行比较，并按队列分层。
在NIP前队列和NIP队列中，分别有16%和9%的人接受了T-PEP，但根据卫生委员会指南并无此必要。此外，分别有8%和7%的人虽符合指南指征却未接受T-PEP。将卫生委员会指南得出的指征与TQS结果进行比较发现，根据卫生委员会指南不符合T-PEP条件但TQS结果为阴性的在NIP前队列中占22%，在NIP队列中占8%。相反，根据卫生委员会指南符合T-PEP条件但TQS结果为阳性，表明破伤风防护充分的在NIP前队列中占36%，在NIP队列中占73%。
使用TQS可使T-PEP的针对性更强。此外，更严格地遵循卫生委员会指南可预防过度免疫并降低破伤风风险。
