Structural asymmetry in knowledge of active and passive tetanus immunization among frontline healthcare workers: Implications for adult booster policy in China.
Frontline healthcare providers show strong recognition of tetanus symptoms but lack adequate knowledge of immunization schedules, which could impact patient care.
Where it sits
this study against the rest of the frag 176-191 corpusSummary and findings
A cross-sectional survey assessed the knowledge of tetanus immunization among 343 healthcare professionals in China. Key findings indicated that only 12.24% correctly identified the five-dose childhood schedule and 35.57% recognized the recommended 10-year adult booster interval. The study highlights a significant knowledge gap regarding active immunization among frontline healthcare workers.
Abstract
Despite sustained high childhood tetanus vaccination coverage in China, adult booster immunization has not been institutionalized, leaving a substantial immunity gap. Frontline healthcare providers play a critical role in post-exposure prophylaxis decisions; however, their knowledge regarding tetanus immunization remains inadequately characterized We conducted a cross-sectional survey among 343 healthcare professionals working in 22 emergency departments and 39 dog bite clinics in Quzhou, China. A validated questionnaire assessed knowledge of tetanus disease, active immunization schedules, and passive immunization use. Knowledge scores were categorized into quartiles and analyzed using ordered logistic regression. Recognition of key clinical manifestations ranged from 94.75% (325/343) to 97.67% (335/343). In contrast, knowledge regarding active immunization was markedly limited: only 12.24% (42/343) correctly identified the five-dose childhood schedule and 35.57% (122/343) recognized the recommended 10y adult booster interval. Awareness that tetanus may occur without a clear trauma history was 33.24% (114/343). Among respondents with prior clinical experience managing tetanus, knowledge of wound management was high (94.87%, 74/78), whereas understanding of long-term immunization strategies remained low (14.10%, 11/78-39.74%, 31/78), indicating a procedural-preventive knowledge imbalance. Institution type, vaccine availability at the institution, occupational role, educational level, and prior training were independently associated with higher knowledge scores (all <i>P</i> < .05). Frontline providers demonstrated adequate clinical recognition but insufficient understanding of active immunization and adult booster strategies. This imbalance may contribute to inappropriate reliance on passive immunization in trauma settings. Strengthening guideline-based training and improving institutional vaccine accessibility are essential to optimize tetanus prophylaxis practices and support adult immunization policy development.
Background
This paper addresses the knowledge gaps in tetanus immunization among frontline healthcare workers in China, particularly in the context of adult booster immunization. Previous studies have indicated high childhood vaccination rates, yet adult booster immunization remains underutilized. Understanding healthcare providers' knowledge is crucial for improving immunization practices and policies.
Methods
A cross-sectional survey was conducted among 343 healthcare professionals in 22 emergency departments and 39 dog bite clinics in Quzhou, China. A validated questionnaire assessed knowledge of tetanus disease, active immunization schedules, and passive immunization use. Knowledge scores were categorized into quartiles and analyzed using ordered logistic regression.
Results
The primary finding revealed that only 12.24% (42/343) of respondents correctly identified the five-dose childhood schedule for tetanus immunization. Recognition of key clinical manifestations was high, ranging from 94.75% to 97.67%. However, knowledge regarding active immunization and adult booster strategies was significantly limited, with only 35.57% recognizing the 10-year booster interval.
Interpretation
The findings suggest a concerning imbalance in knowledge among healthcare providers, where clinical recognition is high but understanding of immunization strategies is low. This discrepancy may lead to inappropriate reliance on passive immunization in trauma settings. Compared to prior literature, these results highlight the need for enhanced training and improved access to vaccines to support adult immunization policies.
Key findings
- Recognition of key clinical manifestations ranged from 94.75% (325/343) to 97.67% (335/343).
- Only 12.24% (42/343) correctly identified the five-dose childhood schedule.
- 35.57% (122/343) recognized the recommended 10y adult booster interval.
- Awareness that tetanus may occur without a clear trauma history was 33.24% (114/343).
- Knowledge of wound management was high at 94.87% (74/78) among those with prior clinical experience managing tetanus.
- Understanding of long-term immunization strategies remained low at 14.10% (11/78) to 39.74% (31/78).
Limitations
- cross-sectional design limits causal inference
- self-reported knowledge may not reflect actual practice
- sample may not be representative of all healthcare providers in China