Technique for emergency tetanus prophylaxis. An example of a medical history entry. Purified adsorbed tetanus anatoxin

Tetanus toxoid is used against tetanus (to form active immunity) during routine vaccinations, as well as, if necessary, for emergency tetanus toxoid vaccination. Thanks to the course of immunization, which includes primary and revaccination, vaccinated patients develop strong immunity against this pathology.

general characteristics

Tetanus toxoid (instruction for use is attached to the vaccine) is a white-yellow suspension, which, when settling, is separated into a precipitate and a clear liquid.

The drug contains tetanus toxin neutralized by heat and formaldehyde, which is purified from proteins and adsorbed by aluminum hydroxide gel.

Components

One (0.5 ml) vaccine dose contains: 10 units of tetanus toxoid, aluminum hydroxide less than 0.55 mg, 40-60 micrograms of a preservative (merthiolate) and formaldehyde less than 100 micrograms.

Release form and properties

The drug is a suspension for injection, poured into ampoules of 2 vaccine doses each. The cardboard package contains 10 such ampoules and instructions for use.

The introduction of tetanus toxoid provides the formation of antitoxic specific antitetanus immunity.

Indications for use

• Scheduled immunization.
• Emergency prophylaxis of tetanus.

Dosages and methods of application

The tetanus toxoid vaccine is injected subcutaneously deep under the shoulder blade, 0.5 ml each.

Immunization active:

• The course of vaccination with tetanus toxoid includes 2 vaccinations with a difference of 30-40 days and subsequent revaccination after six months or a year. Further revaccinations are carried out every 10 years (this scheme is relevant for patients who have not previously been vaccinated against tetanus).
• In the case of an unorganized population, vaccination can be carried out according to a shortened course: a single injection of a double dose of toxoid, then revaccination after 6 months. (allowed up to 2 years) and further revaccinations every 10 years (one (0.5) dose).
• Children from 3 months of age are routinely vaccinated with DTP vaccine.

Emergency prophylaxis is indicated for:

• penetrating lesions of the gastrointestinal tract;
• injuries that are accompanied by a violation of the integrity of the mucous membranes and skin;
• animal bites;
• community abortions;
• long abscesses, gangrene, necrosis;
• childbirth outside health facilities;
• burns (degree 2, 3, 4) and frostbite.

Such urgent tetanus prophylaxis includes mandatory wound debridement and early administration of tetanus toxoid vaccine. What are the following drugs used for?

• Tetanus toxoid (instruction for use says: injected subcutaneously deep under the shoulder blade).
• Human tetanus immunoglobulin (250 units intramuscularly in the buttock).
• Serum horse tetanus toxoid concentrated liquid purified (3000 units subcutaneously). Before using this drug, it is necessary to determine the sensitivity - the implementation of intradermal tests with serum, at a dilution of 1:100.

Side Effects

Tetanus toxoid is a weakly reactogenic preparation.

In rare cases, within two days after vaccination, rapidly passing general (malaise, hyperthermia) and local (swelling, hyperemia) manifestations may occur. Extremely rarely, allergic reactions occur in the form of urticaria, Quincke's edema and polymorphic rash, and in especially sensitive patients to tetanus toxoid, an immediate type reaction. In view of this, after vaccination, the patient is observed for half an hour, and all vaccination points are provided with anti-shock drugs.

Contraindications

For emergency prevention - none.

Routine vaccination should not be given to pregnant women and patients who are particularly sensitive to the drug.

Features of use

• It is forbidden to use the drug in case of damage to the ampoule, lack of labeling, improper storage, expired use and changes in the physical properties of the contents (turbidity, sediment, discoloration).
• Opening of ampoules and vaccination are carried out in compliance with antiseptics and asepsis.
• The drug is not stored in an opened ampoule.
• Each vaccination is registered in special forms for accounting, indicating the date of administration, manufacturer, series and expiration dates.
• Patients who have undergone acute pathologies are vaccinated no earlier than 30 days after recovery.
• In the case of chronic pathologies, vaccination should be carried out a month after the onset of remission.
• Babies with neurological diseases are vaccinated after the process subsides.
• Patients with allergic diseases are immunized 2-4 weeks after the onset of remission, while persistent manifestations of pathology (hidden bronchospasm or localized skin manifestations) are not a contraindication for vaccination.
• In the presence of HIV and other immunodeficiencies, tetanus prophylaxis is carried out as usual; in the treatment of corticosteroids and anticonvulsants, vaccination is carried out a year after the end of therapy.
• To determine possible contraindications on the day of vaccination, the doctor interviews the parents and examines the child, be sure to measure his temperature.

Conditions and terms of storage, vacation

The tool is stored at a temperature of 2-8 degrees for 3 years. You can not freeze tetanus toxoid.

It is dispensed from pharmacies exclusively for healthcare facilities.

The vaccine is produced in the RF FDUP NVO "Microgen".

Drug choice for emergency tetanus prophylaxis

In the presence of documents on the passage of vaccination:

If there are no records of previous vaccinations:

• For emergency anti-tetanus prophylaxis for children under 5 months of age, in the absence of contraindications to immunization, the drugs of choice are anti-tetanus immunoglobulin (250 units) and anti-tetanus serum (3000 units).
• Children from 5 months and adolescents in the absence of a history of contraindications to vaccination are recommended to administer 1 dose of tetanus toxoid.
• Military personnel (current and former) for the prevention of (emergency) tetanus, provided there is no history of contraindications for immunization, the introduction of 0.5 (1 dose) of tetanus toxoid is recommended.
• For all other contingents and age groups of patients, 3000 units are administered. serum, or 250 units. immunoglobulin, or 2 doses of tetanus toxoid.

It may be required in emergency situations, accompanied by a violation of the integrity of the skin. For this, several drugs are used. The introduction should be carried out strictly by a specialist, taking into account the general condition of the victim. What drugs are used? Why is prevention carried out?

Tetanus

This disease is caused by a bacterial pathogen. Infection occurs by contact, when microorganisms enter the bloodstream through damaged skin. The disease is dangerous because its target is the central nervous system. Her defeat is characterized by severe generalized convulsions and general tension in skeletal muscle tone.

Clinical manifestations are associated with the fact that, getting into the human body, the bacterium begins to produce tetanus toxin. Tetanospasmin, which is part of it, causes pronounced tonic muscle contractions. In addition, tetanohemolysin accumulates in the body, which causes damage and death of red blood cells (hemolysis). An uncoordinated distribution of impulses is noted, and the excitability of the cerebral cortex increases. In the future, the respiratory center is affected, which can lead to death.

Anatoxin

Purified and adsorbed on the gel, tetanus toxoid is used to form immunity to the pathogen. It is used for planned and emergency prevention.

After recovery, the patient does not acquire immunity to the pathogen. This suggests that there is a risk of re-infection. That is why it is necessary to use tetanus toxoid. Outwardly, it is a yellowish suspension. During storage, it is divided into two parts - a clear liquid and a precipitate. Available in 0.5 ml, which is one vaccination dose. This amount contains tetanus toxoid - 10 EU. It also contains a sorbent and a preservative. Liquid for injection is in ampoules of 1 ml.

Carrying out emergency prevention

To prevent the development of the disease, the following drugs are administered: tetanus toxoid, antitetanus immunoglobulin and The choice of one or another drug, their combination depends on the clinical case. If they were delivered and the person has documentation confirming this fact, prophylactic injections are not carried out. Skipping only one last scheduled vaccination is an indication for the introduction of toxoid. If several injections were missed, then a combination of toxoid and immunoglobulin is required. Serum is administered to children under 5 months of age, in whom planned prophylaxis has not yet been carried out. The most difficult situation is with pregnant women. In such cases, any introduction of prophylactic drugs in the first half of pregnancy is prohibited, and in the second, only serums are contraindicated. That is why the planned prevention of the disease is so important.

Tetanus toxoid is often used. Although the instruction is simple, it can only be introduced in specialized institutions.

Planned Prevention

To prevent the occurrence of such a formidable disease as tetanus, the timely introduction of a combined vaccine, carried out in a planned manner, helps. Tetanus toxoid is the neutralized toxins of tetanus bacteria. They cannot harm the body, on the contrary, they contribute to the formation of substances to combat the active toxin. The use of toxoid is the basis of prevention.

At the moment, the DTP vaccine is used for planned prophylaxis - not only against tetanus, but also pertussis and diphtheria.

Tetanus anatoxin: instructions for use

The vaccine is administered routinely and intramuscularly, subcutaneous injections are not allowed, as they lead to the formation of seals. It is preferable to inject the drug into the deltoid muscle in the adult population and into the anterior-lateral surface of the leg (middle) in children under 3 years of age. The routine prophylaxis procedure includes three vaccines. They are administered, observing an interval of 1.5 months and starting from 2 months of the baby's life. Revaccination - a year after the third.

Side effects

Vaccinations often lead to mild side effects. This indicates the correct formation of the immune system and will soon pass. However, parents should be alert and contact their pediatrician if the reaction to the vaccine is severe. At the injection site, a local reaction may normally occur - a slight swelling, hyperemia and soreness. The child is concerned about loss of appetite, vomiting, fever and diarrhea. If necessary, antipyretic drugs are allowed. Among the complications, an allergic reaction is distinguished. It is not harmful if it manifests itself only as a skin rash. However, if the baby has developed Quincke's edema or convulsions, you should immediately call an ambulance. In any case, planned prophylaxis should be supervised by a pediatrician at all stages. This will avoid serious complications. Specialists will ensure the correct administration of a drug such as tetanus toxoid. It must be used strictly according to the instructions.

Prevention is a mandatory event that is carried out in a planned manner. Such a complex helps prevent the development of tetanus, which is considered an extremely dangerous disease.

This tool is available in the form of a suspension of a yellowish-white hue, intended for internal administration.

pharmachologic effect

The medicine is for active immunization against .

Pharmacodynamics and pharmacokinetics

Tetanus toxoid (Anatoxin-AC) is characterized by antitoxic , immunocorrective and immunomodulatory action. The introduction of the drug leads to the formation immune response against tetanus with the formation of specific

After vaccination, the human body becomes immune to these foreign agents. The effect of the drug can last up to several years. But for persistent immunity to infection, it is necessary to do several injections .

Indications for use

This tool is used for active immunization against tetanus and in case of need for urgent prophylaxis tetanus with or tissues, injuries with violation of the integrity of the skin and mucous membranes, community-acquired, animal bites, frostbite and burns , childbirth outside medical institutions, penetrating damage to the gastrointestinal tract.

Contraindications

There are no contraindications for urgent tetanus prophylaxis. In the event of a planned vaccination tetanus toxoid not used for acute infectious diseases and chronic diseases at the stage of exacerbation. In addition, it is contraindicated in the first trimester, in case of immunodeficiency states , a negative reaction to the components of the drug.

Side effects

In general, the occurrence of such negative reactions as malaise , temperature rise, . These symptoms usually go away on their own within two days.

In addition, local side effects sometimes develop, such as redness or pain at the injection site. They also pass on their own within two days.

With the appearance of adverse reactions, it is not required to cancel the use of the drug. In some cases, it may be necessary to increase the time interval between drug administrations.

When applied tetanus toxoid may also appear: polymorphic rash , . For this reason, patients should be monitored for 30 minutes after injection. The vaccination site must be equipped with antishock therapy .

Application instruction of Anatoxin Tetanus (Method and dosage)

Instructions for Anatoxin Tetanus reports that the drug is injected subcutaneously into the area under the scapula. Full course injections for people who have not previously been vaccinated against tetanus , includes two vaccinations 0.5 ml. Between them there should be a break of 30-40 days. Subsequent revaccination are carried out six months or a year later in the same dosage. In some cases, this interval is extended up to 2 years. Next are revaccination every 10 years. The drug is administered once at a dosage of 0.5 ml.

Vaccinations some hard-to-reach populations may be carried out on an abbreviated basis. In this case injection do in double dosage. First revaccination carried out after 6-24 months. Further revaccination are held every 10 years. Dosage - 0.5 ml.

Active vaccination children (age from 3 months) vs. tetanus carry out ADS-anatoxin , or -anatoxin following the instructions for use.

Revaccination adult patients fully vaccinated with associated agents, including tetanus toxoid are carried out every 10 years.

If you need emergency prophylaxis tetanus primary surgical treatment of the wound. injection should be done as soon as possible from the moment of injury up to 20 days. AC toxoid is used, tetanus toxoid human immunoglobulin . If it is missing, you can use tetanus toxoid horse serum , which is purified by peptic digestion.

AC toxoid is injected under the shoulder blade subcutaneously . Dosages PSFI – 250ME intramuscularly . Injections done in the upper outer quadrant of the buttocks. In its turn, PSS introduced subcutaneously at a dosage of 3000 ME.

Overdose

Information about overdose is not provided.

Interaction

In the case of emergency prophylaxis, Tetanus Anatoxin must be injected into different areas. For this, various syringes are used.

Terms of sale

This drug is the same as Anatoxin Cholerogen and many others toxoids , not sold in the pharmacy chain. It is supplied only to medical institutions.

Storage conditions

Keep the drug in a dry and dark place. The optimum temperature is about 6°C. Ampoules must not be frozen. They can also be transported at a temperature of about 6°C in covered vehicles.

Active immunization of children against tetanus from 3 months is carried out in a planned manner with adsorbed pertussis-diphtheria-tetanus vaccine (DPT-vaccine) or adsorbed diphtheria-tetanus toxoid (ADS or ADS-M-toxoid).

Emergency specific prophylaxis of tetanus is carried out with: injuries with violation of the integrity of the skin and mucous membranes; frostbite and burns (thermal, chemical, radiation) of the second, third and fourth degree; community abortions; childbirth outside medical institutions; gangrene or tissue necrosis of any type, long-term abscesses; animal bites; penetrating damage to the gastrointestinal tract. Emergency prophylaxis of tetanus involves the primary surgical treatment of the wound and the creation, if necessary, of specific immunity against tetanus. Emergency tetanus immunoprophylaxis should be carried out as early as possible after injury, up to 20 days, given the length of the incubation period for tetanus.

For emergency specific prophylaxis of tetanus, anti-tetanus toxoid and anti-tetanus human Ig are used, and in the absence of the latter, anti-tetanus serum.

Considering the possibility of developing immediate allergic reactions in particularly sensitive individuals, patients should be monitored medically for 30 minutes. Vaccination sites should be provided with anti-shock therapy.

Persons who have had acute diseases are vaccinated no earlier than 1 month after recovery.

Patients with chronic diseases are vaccinated 1 month after the onset of remission. Children with neurological changes are vaccinated after exclusion of the progression of the process. In case of exacerbation of allergic diseases, vaccinations are carried out 2-4 weeks after recovery. At the same time, stable manifestations of the disease (localized skin phenomena, latent bronchospasm, etc.) are not contraindications to vaccination, which can be carried out against the background of appropriate therapy.

Immunodeficiency, HIV infection, as well as maintenance course therapy (including steroid hormones and anticonvulsants) are not contraindications to vaccination. Vaccination is carried out 12 months after the end of treatment.

In order to identify contraindications, the doctor on the day of vaccination conducts a survey of parents and an examination of the child with mandatory thermometry. Children temporarily exempted from vaccination should be taken under observation and account and vaccinated in a timely manner.

The opening of the ampoules and the vaccination procedure is carried out with strict observance of the rules of asepsis and antisepsis. The drug in the opened ampoule is not subject to storage.

The drug is not suitable for use in ampoules with broken integrity, lack of labeling, with a change in physical properties (color change, the presence of unbreakable flakes and foreign inclusions), improper storage.

AS-anatoxin: instructions for use

Compound

Description

Indications for use

Clinical contraindications for routine vaccinations with AS-anatoxin:

1. Acute infectious and non-infectious diseases - vaccination is carried out no earlier than one month after recovery.

2. Exacerbation of chronic diseases - vaccination is carried out in a state of clinical and laboratory remission.

3. Long-term and severe diseases (viral hepatitis, tuberculosis, meningitis, myocarditis, diffuse connective tissue diseases, etc.) - vaccination is carried out individually 6-12 months after recovery.

4. Severe forms of allergic reactions to the administration of ADS, ADS-M, AD-M, AS-anatoxins (shock, Quincke's edema, polymorphic exudative erythema, etc.).

5. Severe post-vaccination reactions in the form of anaphylactic shock, encephalitis, agranulocytosis - vaccination is carried out no earlier than 6 months after recovery (remission).

6. Hereditary and progressive neurological and articular diseases, sub- and decompensated hydrocephalus, acute cerebrovascular accidents, convulsions more than once every 6 months, epilepsy and epileptic syndrome with seizures not more than one attack in 6 months.

Note. Children with non-progressive cerebral palsy and other stable neurological disorders can be vaccinated with ADS-M toxoid after one year of age; children with a history of seizures can be vaccinated with ADS-M toxoid 6 months after the seizure against the background of anticonvulsant therapy.

7. Immune disorders: oncological diseases, immunosuppression as a result of cytostatic therapy and the use of corticosteroids for more than 14 days. Such children can be vaccinated 1 month after the abolition of these treatments.

8. Anemia: contraindications for vaccination are patients with hemoglobin levels below 80 g/l.

Vaccination with AS-anatoxin is carried out no earlier than 2 months after vaccinations against other infections.

In each individual case of a disease that is not on the list of contraindications, the question

about contraindications regarding vaccination is decided by the commission.

In order to identify contraindications, the doctor (feldsher FAP) on the day of vaccination conducts a survey and examination of persons who are vaccinated, with mandatory thermometry. Persons temporarily exempted from vaccinations should be monitored and registered and vaccinated in a timely manner after the removal of contraindications.

Contraindications

1. A history of hypersensitivity to the respective drug.

2. Pregnancy:

• in the first half, the introduction of AS-anatoxin and PSS is contraindicated;
• in the second half, the introduction of PSS is contraindicated.

Dosage and administration

1. Active immunization

The drug is injected subcutaneously into the subscapular region. A full course of immunization with AS-anatoxin for adults consists of two inoculations of 0.5 ml each with an interval of 30-40 days and revaccination after 6-12 months with the same dose. With an abbreviated scheme, the full course of immunization includes a single vaccination with AC-anatoxin at a double dose (1.0 ml), revaccination after 1-2 years with a dose of 0.5 ml, and then every 10 years.

Immunization of some contingents of the population (elderly people, unorganized population), taking into account the specific conditions in certain areas, by decision of the Ministry of Health of Ukraine, can be carried out according to an abbreviated scheme, providing for a single vaccination with AC-anatoxin in a double dose (1.0 ml) and revaccination after 1-2 years with a dose of 0.5 ml and then every 10 years.

Note;

1. Active immunization of children against tetanus at the age of 3 months is carried out in a planned manner with adsorbed pertussis diphtheria-tetanus vaccine (DTP-vaccine) or adsorbed diphtheria-tetanus toxoid (ADS-anatoxin, ADS-M-anatoxin) in accordance with the guidelines for " the use of drugs.

2. Revaccination of adults previously fully immunized with associated preparations containing tetanus toxoid is performed every 10 years with AS- or ADS-M-toxoids at a dose of 0.5 ml.

3. Persons who have not previously been vaccinated against tetanus (from 26 to 56 years old), who received ADS-M toxoid for the prevention of diphtheria once, to form full-fledged immunity to tetanus 30-40 days after the administration of ADS-M toxoid, AC-toxoid is administered at a dose of 0.5 ml. Revaccination is carried out after 6-12 months once with the same dose of AC-toxoid.

2.Tetanus emergency prophylaxis

Emergency prophylaxis of tetanus includes primary surgical debridement and simultaneous specific immunoprophylaxis.

Emergency specific prophylaxis of tetanus is indicated for:

Injuries with violation of the integrity of the skin and mucous membranes;

Frostbite and burns (thermal, chemical, radiation) of the second, third and fourth degree;

community-acquired abortions;

Childbirth outside medical institutions;

Gangrene or tissue necrosis of any stage; abscesses;

Animal bites;

Penetrating damage to the gastrointestinal tract.

For emergency specific prophylaxis of tetanus, apply:

Adsorbed tetanus toxoid (AS-a);

Adsorbed diphtheria-tetanus toxoid (ADS-a) with a reduced content of antigens (ADS-M-a);

Tetanus toxoid human immunoglobulin (PSHI), made from the blood of immune people. One prophylactic dose of PSNI contains 250 international units (IU);

Anti-tetanus serum (PSS) obtained from the blood of hyperimmune horses. One prophylactic dose of PSS is 3000 IU.

The scheme for choosing prophylactic agents during emergency specific prophylaxis of tetanus is presented in table No. 1.

AS-anatoxin is injected subcutaneously into the subscapular region.

PSCI is administered at a dose of 250 IU intramuscularly in the upper-outer quadrant of the buttock.

PSS is administered at a dose of 3000 IU under the skin.

Before the introduction of PSS, an intradermal test with horse serum diluted 1:100 is required to determine the sensitivity to horse serum proteins (the ampoule is marked in red).

To conduct an intradermal test, an individual ampoule and a sterile syringe with divisions of 0.1 ml and a thin needle are used.

The diluted serum is injected intradermally into the flexor surface of the forearm in a volume of 0.1 ml. Accounting for the reaction is carried out after 20 minutes. The sample is considered negative if the diameter of the edema or redness at the injection site is less than 1.0 cm. The sample is considered positive if the edema or redness reaches 1.0 cm or more in diameter. In case of a negative skin test, PSS (from an ampoule marked in blue) is injected subcutaneously in a volume of 0.1 ml. If there is no reaction after 30 minutes, the rest of the serum dose is injected with a sterile syringe, the ampoule with which should be stored with a closed sterile napkin.

Comment. Individuals with allergic diseases and reactions to various allergens, as well as those who have previously been administered preparations with horse serum (PSS, anti-rabies and oral and encephalic heterogeneous gamma globulins) are recommended to administer antihistamines before the main dose of PSS. Persons with a positive reaction to the intradermal injection of 0.1 ml of 100-fold diluted horse serum, or those who had a reaction to the subcutaneous injection of 0.1 ml of PSS, further administration of PSS is contraindicated.

Active routine immunization and emergency specific prophylaxis of tetanus is carried out in compliance with the following rules:

Before use, the drug ampoule is carefully inspected;

The drug can not be used if there is no label on the ampoule, the presence of cracks in the ampoules, the content of foreign inclusions, the presence of sediment, the expiration date, improper storage;

Immediately before the introduction of AS-anatoxin, the ampoule is shaken until

homogeneous mixture;

Before opening, the ampoule is wiped with cotton wool moistened with alcohol before and after the incision with a file. An open ampoule with AS-toxoid or PSS can be stored, covered with a sterile napkin, for 30 minutes;

The drug is drawn into the syringe from the ampoule with a long needle with a wide lumen. For injection, be sure to use a new needle;

The skin at the injection site for disinfection is wiped with cotton wool moistened with 70% alcohol. After the injection of the drug, the injection site is lubricated with iodine or alcohol.

The vaccinations carried out are recorded in the established accounting forms, indicating the date of vaccination, the list of administered drugs (ADS, PSS, PSCI), doses, time of administration, series, manufacturer of the drug, as well as reactions to the administered drug.

Side effect

After the introduction of AS-anatoxin, both general reactions can be observed, manifested in malaise and fever, as well as local reactions in the form of redness, swelling, pain, passing through 24-48 hours. In exceptional cases, shock may develop. After the introduction of PSS, complications may develop: serum sickness, anaphylactic shock. In this regard, for each vaccinated, it is necessary to establish medical supervision within an hour after the vaccination. When symptoms of shock appear, urgent anti-shock therapy is necessary. The room in which vaccination and emergency specific prophylaxis of tetanus is carried out should be equipped with anti-shock therapy.

Persons receiving PSS should be warned about the need to urgently seek medical help in case of fever, itching and skin rashes, joint pain and other symptoms characteristic of serum sickness.

Release form

Storage conditions

Best before date

Self-medication can be harmful to your health.
It is necessary to consult a doctor, and also read the instructions before use.