Integrating non-neonatal tetanus vaccination into an emergency department rabies PEP clinic: Real-world workload, documentation gaps, and VAERS-informed observation priorities.
The study highlights that 73.6% of animal-bite presentations in the ED are grade III exposures, emphasizing the need for improved documentation and routine tetanus vaccination availability.
Where it sits
this study against the rest of the bofanglutide corpusSummary and findings
This study reviewed 3,365 patients presenting for rabies post-exposure prophylaxis (PEP) in an emergency department from October 8, 2022, to October 31, 2025. It aimed to describe encounter characteristics and quantify workload related to integrated non-neonatal tetanus vaccination. Findings indicated that 73.6% of presentations were grade III exposures, and 93.1% of patients presented on the same day.
Abstract
Animal-bite and scratch visits to the emergency department (ED) often require time-sensitive decisions on rabies post-exposure prophylaxis (PEP) alongside tetanus prevention. In China, recent national standards and local implementation programs have framed non-neonatal tetanus prevention as an integrated medical-public health service model, yet integrated workflows and structured documentation remain uncommon in many tertiary hospitals. We reviewed patients presenting for their first recorded exposure to a dedicated ED rabies PEP clinic (8 Oct 2022-31 Oct 2025; n = 3,365) to describe real-world encounter characteristics and quantify implementation-relevant workload. Grade III exposures accounted for 73.6% of presentations, and 93.1% of patients presented on the same day. While grade III encounters form a practical priority subgroup for tetanus management, grade II/III encounters represented 99.4% of visits, indicating that tetanus immunization-history review and wound tetanus-risk documentation would need to be routine steps for nearly all PEP encounters. However, tetanus-related elements (immunization history, Td/Tdap/TT vaccination, tetanus immunoglobulin/antitoxin use) were not captured in structured registry fields, and Td/Tdap/TT vaccination is not routinely available in our ED clinic workflow, highlighting a quality improvement opportunity for standardized implementation. To provide external pharmacovigilance context in the absence of local coadministration safety data, we summarized adult VAERS reports listing both rabies vaccine and Td/Tdap/TT in 2022-2025 (n = 9; serious reports 0/9) and explored predefined disproportionality signals in 2006-2025. In sensitivity analyses, syncope and hypersensitivity showed increased reporting odds in reports listing both vaccines compared with rabies-only reports. These VAERS findings are presented as hypothesis-generating only: they identify potential event categories that may warrant awareness and documentation if multiple vaccines are administered during one encounter, but they do not confirm same-day administration, estimate incidence, or support causal inference.
Background
This paper addresses the integration of non-neonatal tetanus vaccination into rabies post-exposure prophylaxis (PEP) in emergency departments. Previous studies have indicated that animal-bite and scratch visits often require timely decisions on rabies PEP alongside tetanus prevention. The importance of this study lies in its potential to improve the quality of care through better documentation and integrated workflows in emergency settings.
Methods
This was a retrospective review of patients presenting for their first recorded exposure to a dedicated ED rabies PEP clinic, with a total sample size of 3,365. The study spanned from October 8, 2022, to October 31, 2025. Primary outcomes included the characterization of encounter types and quantification of workload related to vaccination.
Results
The primary finding was that grade III exposures accounted for 73.6% of presentations. Additionally, 93.1% of patients presented on the same day, and grade II/III encounters represented 99.4% of visits. Tetanus-related elements were not captured in structured registry fields, indicating a need for improvement in documentation practices.
Interpretation
These findings suggest a significant proportion of encounters could benefit from routine tetanus immunization-history review and documentation. While the study identifies important workload characteristics, the lack of structured data capture and routine vaccination availability limits the conclusions that can be drawn. The VAERS data, while informative, does not confirm same-day administration or support causal inference.
Key findings
- Grade III exposures accounted for 73.6% of presentations.
- 93.1% of patients presented on the same day.
- Grade II/III encounters represented 99.4% of visits.
- 0 serious reports out of 9 VAERS reports listing both rabies vaccine and Td/Tdap/TT.
Limitations
- Not reported in abstract.
- Gaps in structured documentation.
- Routine availability of tetanus vaccinations not established.
- VAERS reports do not confirm same-day administration.