Shrestha Suraj, Aryal Roshan, Yadav Randhir S, Baidya Sujita, Acharya Suman, Bhandari Sanjeeb S
Maharajgunj Medical Campus, Institute of Medicine, Kathmandu.
Kathmandu University School of Medical Sciences, Dhulikhel.
Ann Med Surg (Lond). 2024 Sep 4;86(10):6276-6279. doi: 10.1097/MS9.0000000000002525. eCollection 2024 Oct.
Tetanus, though potentially fatal, is preventable with proper vaccination, but high tetanus titers from frequent or higher doses can lead to increased adverse events. In countries like Nepal, where tetanus vaccines are readily available over the counter, irrational and frequent dosing, especially in certain occupational groups, is a noted issue.
A 28-year-old metal worker presented with a superficial cut on his forearm, managed with standard wound care, and reported a history of frequent tetanus vaccinations. Given his extensive vaccination history, a tetanus toxoid injection was deemed unnecessary, and he was educated on proper vaccination schedules and advised to seek medical attention for future injuries.
Timely administration of vaccines for pre-exposure and postexposure prophylaxis is crucial for combating tetanus, with booster doses recommended every 10 years or as needed for wound management. High antibody titers from frequent tetanus vaccinations can increase the risk of adverse events, prompting guidelines to avoid administering Td more frequently than every 10 years unless necessary. Local reactions, like pain and swelling at the injection site, are common, while systemic reactions can include fever and peripheral neuropathy. Over-immunization is a concern in some regions, with frequent unnecessary booster doses potentially causing harm and highlighting the need for adherence to vaccination guidelines.
Modifying and monitoring adult Td booster vaccination can lead to significant cost savings and fewer adverse events, requiring proper vaccination record-keeping, accurate assessment, and adherence to guidelines by healthcare workers.
破伤风虽然有潜在致命风险，但通过适当接种疫苗可预防，不过频繁接种或接种更高剂量导致破伤风抗体效价升高会增加不良事件发生几率。在尼泊尔等国家，破伤风疫苗可在柜台轻易购得，不合理且频繁接种，尤其是在某些职业群体中，是一个显著问题。
一名28岁金属工人因前臂浅表切割伤前来就诊，接受了标准伤口护理，其报告有频繁接种破伤风疫苗的病史。鉴于其广泛的疫苗接种史，认为无需注射破伤风类毒素，并对其进行了适当接种计划的教育，并建议其未来受伤时寻求医疗护理。
及时进行暴露前和暴露后预防接种疫苗对于预防破伤风至关重要，建议每10年接种加强针或根据伤口处理需要接种。频繁接种破伤风疫苗导致的高抗体效价会增加不良事件风险，促使指南建议除非必要，避免每10年以内更频繁地接种破伤风-白喉联合疫苗（Td）。局部反应，如注射部位疼痛和肿胀很常见，而全身反应可能包括发热和周围神经病变。过度免疫在一些地区是一个问题，频繁不必要的加强针可能造成伤害，凸显了遵守疫苗接种指南的必要性。
调整和监测成人破伤风-白喉联合疫苗加强针接种可显著节省成本并减少不良事件，这需要医护人员妥善保存接种记录、进行准确评估并遵守指南。
