Healthcare-associated Exposure to Clostridium tetani, Corynebacterium diphtheriae, and Bordetella pertussis

Four trivalent vaccines are available to prevent diphtheria, tetanus, and pertussis: DTaP, DT, Tdap, and Td.¹⁸ The upper-case letters “D,” “T,” and “P” denote full-strength doses of diphtheria, tetanus toxoid and pertussis, respectively. The lower-case letters “d” and “p” denote reduced doses of diphtheria and pertussis used in the adolescent/adult-formulations. The “a” in DTaP and Tdap stands for “acellular,” i.e., the pertussis component of the vaccine contains only a part of the organism. Vaccinated HCP should receive a booster dose of Td (or Tdap) every 10 years.

Clostridium tetani (C. tetani)

C. tetani usually enter the body through cuts or puncture wounds caused by contaminated objects. Following exposure, HCP who have not or are unsure if they have previously been vaccinated should receive PEP, i.e., a dose of Tdap as soon as feasible.¹⁸ Exposed HCP should be monitored closely and human tetanus immune globulin (TIG), agents to control muscle spasm, and antibacterial agents should be administered at the first sign(s) of illness.¹⁸

Corynebacterium diphtheriae (C. diphtheriae)

C. diphtheriae is transmitted from person-to-person by direct contact with respiratory secretions or by inhalation of airborne droplets generated by coughing or sneezing.¹⁹ HCP in close contact with patients with diphtheria should be administered PEP, i.e., a dose of diphtheria toxoid booster Td) and antibacterial agents (benzathine penicillin G or oral erythromycin).^12,19 Exposed HCP should be monitored closely and diphtheria antitoxin administered at the first sign(s) of illness.¹⁹

Bordetella pertussis(B. pertussis).

B. pertussis is transmitted from person-to-person by direct contact with respiratory secretions or by inhalation of airborne droplets generated by coughing or sneezing.²⁰ If there is an increased risk of pertussis in a healthcare setting, evidenced by documented or suspected healthcare-associated transmission of pertussis, revaccination of HCP with Tdap should be considered.¹² Revaccination may benefit individual healthcare providers.

However, there is no evidence that revaccination of HCP will prevent pertussis disease and transmission in healthcare settings. The CDC recommends that exposed HCP receive PEP, i.e., antibacterial prophylaxis within 21 days of exposure when (1) the healthcare provider is at high risk of developing severe pertussis or (2) when close contact with patients at high risk of developing severe pertussis is anticipated.¹²