Tdap Utilization In Emergency Departments 2007-2009

Background: Although Tdap has been recommended since 2006, coverage remains suboptimal.   A single dose of Tdap has been recommended in place of Td for adolescents and adults who require tetanus toxoid-containing vaccine as part of wound management. This provides an opportunity for emergency departments to play a significant role in Tdap vaccination.

Objectives: To describe national patterns of Tdap administration during emergency department visits when tetanus toxoid is warranted.

Methods: The National Hospital Ambulatory Medical Care Survey (NHAMCS) is an annual survey of visits to hospital emergency and outpatient departments in the United States.  NHAMCS data from 2007-2009 were used to establish patterns of tetanus toxoid-containing vaccination in emergency departments and to identify factors associated with Tdap receipt.  All results were weighted to provide nationally representative estimates.

Results: A tetanus toxoid-containing vaccine was administered during 8,200,000 (95% confidence interval (CI) 7,200,000 – 8,700,000) of the nearly 380 million emergency department visits during the study period.  Tdap accounted for only 4.4% (95% CI 3.5-5.7%) of the tetanus-containing vaccines administered.  Due to the low receipt of Tdap in 2007 and 2008 reliable national estimates could not be calculated; data from these years were pooled.  The percentage of Tdap among all toxoid-containing vaccines increased from 4.0% (95% CI 2.9 – 5.6%) in 2007-08 to 5.2% (95% CI 3.6-7.4%) in 2009.  Due to low uptake, independent factors associated with Tdap receipt could not be validly and reliably determined.

Conclusions: In the face of ongoing pertussis outbreaks, strategies to maximize Tdap vaccination are needed.  Routine Tdap use for wound prophylaxis in the emergency department may provide an effective mechanism to increase uptake.  The reasons for underutilization of Tdap in the emergency department setting warrant further investigation.