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

Four vaccines are available to prevent diphtheria, tetanus, and pertussis: DTaP, DT, Tdap, and Td.¹⁷ 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 the “a” in DTaP and Tdap stands for “acellular,” i.e., the pertussis component of the vaccine contains only a part of the organism. DTaP and DT are prescribed to immunize children younger than 7 years old.¹⁷

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 Td or Tdap) 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.¹⁰ Regardless of age, HCP should receive a single dose of Tdap as soon as feasible if they have not previously received Tdap and regardless of the time since their most recent Td vaccination.¹⁰ Booster doses of either Td or Tdap should be administered every 10 years throughout life.

Some vaccinated HCP exposed to B. pertussis may experience a breakthrough infection and need postexposure prophylaxis. Postexposure antimicrobial prophylaxis is recommended for all HCP who have unprotected exposure to pertussis and are likely to expose a patient at risk for severe pertussis (e.g., hospitalized neonates and pregnant women). Other HCP should either receive postexposure antimicrobial prophylaxis or be monitored daily for 21 days after pertussis exposure and treated at the onset of signs and symptoms of pertussis.¹⁰