Background The incidence of tetanus in Spain is one of the highest in the developed world, especially among men over 60 years of age in rural areas. Tetanus is a notifiable disease. Vaccine rejection can lead to serious illness; some 50 cases are recorded yearly in this country.
Purpose Cost-benefit analysis associated with caring for a patient who has rejected voluntary vaccination when reporting a dirty wound.
Material and methods An 82-year-old man reported to the emergency department with an incised wound on the side of his left hand which he had carried for 15 days from a rabbit scratch; he had received no anti-tetanus prophylaxis due to voluntary rejection of vaccination. The patient was admitted from 14 April 2015 to 1 July 2015. On arrival in the intensive care unit (ICU), the patient presented II/III grade tetanus (difficulty in swallowing liquids and solids, sardonic laugh, increased muscle tone in the phalanges of the left hand). Economic calculations were based on APD for medication management, data from the Clinical Management and Documentation Unit and Silicon for electronic prescriptions, and Web Reporting for Pyxis data trials.
Results The patient spent 79 days in hospital: 65 in ICU and 14 in the infectious diseases unit (IDU). The cost amounted to 121 225€ (ICU) and 28 448€ (IDU). Pharmacological treatment cost 8938€ (ICU) and 228€ (IDU), including tetanus specific drugs such as midazolam, cisatracurium and pralidoxime. Once diagnosed with tetanus, the patient was given the tetanus vaccine with gamma globulin (15.24€).
Conclusion Total cost: 149 673€, against 15.24€ for preventive vaccine with gamma globulin. Vaccination compliance, including top-ups every 10 years, or complete vaccination at the moment of the accident, would have drastically reduced the risk of contracting tetanus. Evidently, vaccination schedule must be strictly adhered to, even in adulthood, and primary care services must stress the social and economic importance of repeat vaccinations.
References and/or Acknowledgements
Tétanos. Mariscal Sistiaga F, Galván Guijo B, Palma Gámiz A. Medicina Crítica Práctica. Patología Nueromuscular que cursa con alteraciones respiratorias. 2004. ISBN: 84-7877-349-5
Guía de Vacunas. Consejo General de Colegios Oficiales de Farmacéuticos, 2009
References and/or AcknowledgementsNo conflict of interest.
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