Background: Recommendations for vaccination of injured patients against infection are evolving.
Newly-recognized infections, safety considerations, changing epidemiology, and redefinition
of patient groups at risk are factors that may influence vaccine development priorities
and recommendations for immunization. However, recommendations must often be formulated
based on incomplete data, forcing reliance on expert opinion to address some crucial
questions. These guidelines provide evidence-based recommendations for the prevention or
treatment of infectious morbidity and mortality after traumatic injury, such as soft tissue
wounds, human or animal bites, or after splenectomy.
Methods: A panel of experts conducted a thorough review of published literature, as well
as information posted on the internet at the websites of the U.S. Centers for Disease Control
and Prevention, among others. MEDLINE was searched for the period 1966–2004 using relevant
terms including "anthrax," "rabies," "tetanus," "tetanus toxoid," and " splenectomy," in
combination with "vaccine" and "immunization." The Cochrane database was searched
also. Reference lists were cross-referenced for additional relevant citations. All published reports
were analyzed for quality and graded, with the strength of the recommendation proportionate
to the quality of the supporting evidence.
Results: Recommendations are provided for pre- and post-exposure prophylaxis of rabies
and anthrax. For tetanus prophylaxis, recommendations are provided for prophylaxis of acute
wounds stratified y age and prior immunization status, and for immunization of persons at
high risk. After splenectomy, it is recommended that all persons ages 2–64 years receive 23-
valent pneumococcal vaccine and meningococcal vaccine, with Haemophilus influenzae type
B vaccine administered to high-risk patients as well (all are Grade D recommendations). Vaccination
should be given two weeks before elective splenectomy (Grade C), or two weeks after
emergency splenectomy (Grade D). A booster dose of pneumococcal vaccine is recommended
after five years (Grade D); no re- vaccination recommendation is made for
meningococcal or Haemophilus influenzae type B vaccine. Recommendations for prophylaxis
of splenectomized children under the age of five years are also provided.
Conclusion: There are limited data on the use of vaccines after injury. This document brings
together a disparate literature of variable quality into a discussion of the infectious risks after
injury relevant to vaccine administration, a summary of safety and adverse effects of vaccines,
and evidence-based recommendations for vaccination.
