Tetanus toxoid vaccination uptake by trauma patients in Japan: A retrospective cohort study using large administrative claims data

Abstract

Tetanus remains a major global health issue in both developing and developed countries. Although guidelines are established on tetanus prophylaxis protocol for trauma patients, adherence to tetanus vaccination is unknown. In this study, we aimed to investigate the administration of tetanus toxoid among trauma patients in Japan, where approximately 100 patients are hospitalized for tetanus annually. Using the JMDC claims database, a large administrative claims database, we identified outpatients with trauma between 2005 and 2020. We divided them into those born before 1968 and those born in 1968 or later, as the routine tetanus immunization program started in 1968 in Japan. We described the characteristics of the patients and whether they received the first dose of tetanus toxoid when they visited a medical institution for any injury. Finally, we followed up the patients who received the first tetanus toxoid dose and had a history of incomplete primary vaccination series to examine whether they completed the recommended three doses of tetanus immunization within 12 months. We identified 85,761 trauma patients from the database, of whom 19,541 (22.8 %) were born before 1968 and not covered by the routine vaccination program. Among the patients covered by the routine vaccination program, 2.1 % (1400/66,220) received tetanus toxoid vaccination at the initial clinic/hospital visit for their injuries, whereas the proportion was 5.8 % (1139/19,541) in the patients not covered by the routine vaccination program. Among the 1139 patients who received tetanus prophylaxis at the time of wound management and were born before the implementation of the routine vaccination program, 31.4 % received the second dose, and 7.0 % completed the third dose within 12 months. Taken together, most trauma patients without a history of primary tetanus immunization did not receive the recommended tetanus prophylaxis. Increased awareness of tetanus prophylaxis is needed among both patients and healthcare professionals.