Tetanus prevention measures consist of inducing active immunity through vaccination and passive immunity through antitoxins. Prophylaxis depends on injury and patient immunization status. Prevention must be considered for mass casualty events. Pneumococcal vaccines like PCV7 and PCV13 have greatly reduced invasive pneumococcal disease in children by preventing the most common serotypes through active immunization. High-risk children may additionally benefit from PPSV23 which covers more serotypes but has uncertain clinical efficacy in children under 2.

1. Tetanus prevention

2. • Tetanus prevention measures after trauma consist of
inducing active immunity to tetanus toxin and of
passively providing antitoxic antibody.
• Tetanus prophylaxis is an essential part of all wound
management, but specific measures depend on the
nature of the injury and the immunization status of the
patient.
• Prevention of tetanus must be included in planning for
the consequences of bombings, natural disasters, and
other possible civilian mass-casualty events

5. • Tetanus toxoid should always be given after a dog or other animal
bite, even though C. tetani is infrequently found in canine mouth
flora
• Patients with an unknown or incomplete immunization history;
crush, puncture, or projectile wounds; wounds contaminated with
saliva, soil, or feces; avulsion injuries; compound fractures; or
frostbite, TIG 250 units should be administered intramuscularly,
regardless of the patient's age or weight.
• If TIG is unavailable, use of human IVIG may be considered. If
neither of these products is available, 3,000-5,000 units of equine-
derived TAT (in regions of the world where it is available) may be
given intramuscularly after testing for hypersensitivity.
• Serum sickness may occur with TAT

6. PREVENTION OF
S.PNEUMONIA

7. • The highly successful PCVs have resulted in a
marked decrease in IPIs in children.
• PCVs provoke protective antibody responses
in 90% of infants given these vaccines at 2, 4,
and 6 mo of age, and greatly enhanced
responses (e.g., immunologic memory) are
apparent after vaccine doses given at 12-15 mo
of age

8. • In a large clinical trial, PCV7 was shown to
reduce invasive disease caused by vaccine
serotypes by up to 97% and to reduce invasive
disease caused by all serotypes, including
serotypes not in the vaccine, by 89%
• Following PCV13, a 64% reduction in IPIs
caused by vaccine serotypes has been seen,
particularly in children less than 5 years old

9. • The number of cases of pneumococcal meningitis in children remain
unchanged, but the proportion of PCV13 serotypes have decreased
significantly
• Immunologic responsiveness and efficacy after administration of
pneumococcal polysaccharide vaccines (PPSV23) is unpredictable
in children < 2 years old
• PPSV23 contains purified pneumococcal polysaccharide of 23
serotypes responsible for 95% of invasive disease.
• The clinical efficacy of PPSV23 is controversial, and studies have
yielded conflicting results

10. • Immunization with PCV13 is recommended for all infants on a schedule for
primary immunization, in previously unvaccinated infants, and for transition for
those partially vaccinated with PCV7.
• High-risk children ≥2 yr old, may benefit also from PPSV23 administered after 2
yr. of age following priming with the scheduled doses of PCV13.
Asplenia
sickle cell diseases
some types of immune deficiency (e.g., antibody deficiencies),
HIV infection
Cochlear implant
CSF leak
Diabetes mellitus
Chronic lung, heart, or kidney disease (including nephrotic
syndrome)

11. • Thus, it is recommended that children 2 yr of age
and older with these underlying conditions
receive supplemental vaccination with PPSV23.
• A 2nd dose of PPSV23 is recommended 5 yr after
the 1st dose of PPSV23 for persons ≥2 yr old who
are immunocompromised, have sickle cell
disease, or functional or anatomic asplenia.