Antitetanus serum. Antitetanus serum "Microgen"

Antitetanus serum is a drug for emergency prevention of tetanus, one of the most dangerous diseases. Every year about 300 thousand people die from of this disease. According to the frequency of deaths from total number of all sick people, tetanus ranks third among infectious diseases. It is second only to rabies (1st place, 99.9%), pulmonary form plague (2nd place, 95%).

Tetanus: a brief description of diseases.

Tetanus - infection, caused by Clostridium tetani. It is a gram-negative rod that exists only in the absence of oxygen. Otherwise, it forms a spore, which... several times more stable than a bacterial cell. Bacterial spores remain viable in water for up to six months, and in soil for about a decade. When water containing bacterial spores is heated to 100 degrees, they die after 1 hour. According to some data, spores can withstand boiling for up to 1.5 hours.

Infection occurs by contact - through damaged skin and the umbilical cord (in newborns). Once in an oxygen-free environment, at a temperature of at least 37 degrees, spores quickly turn into bacteria. After which, they begin to produce chemical active substance, called tetanus toxin. He's for enough a short time, through the blood, penetrates the central nervous system. Namely, the spinal cord and brain. Here, it acts on the centers that lead to contraction of the striated muscles. As a result, their widespread reduction is noted. Initially, convulsive contractions are noted on the limbs (and, first of all, on the affected limb, and then on the opposite one). Then, it spreads to the stomach, back, chest. After which come the neck. Finally, there is a spasm of the diaphragm and other respiratory muscles, which ultimately leads to death from respiratory arrest. In addition, tetanus toxin leads to the destruction of red blood cells. Therefore, with a slower progression of the disease, acute anemia may develop. This independently worsens the patient’s condition - shortness of breath, palpitations, and severe weakness develop. But still, the majority deaths happens against the background of seizures.

Emergency and planned prevention.

Despite modern development medicine, the mortality rate from tetanus is quite high level. First of all, this is due to the fact that the amount of toxin produced by bacteria is significantly lower than that required to form an effective immune response. In addition, the action of toxins occurs in the nervous system, which has the so-called immune privilege. That is, normally, its cells and the space around them are protected from the penetration of cells and immune factors.

Due to this, best results provides prevention, both planned and emergency, as well as the use of anti-tetanus serum. Prevention consists of three vaccinations for children from birth to 1.5 years of age, then repeated vaccination three times until the age of 18 and then every ten years. Emergency prevention involves the use of antitetanus serum for known infected lesions skin(wounds, open fractures, burns, frostbite). It contains special chemical compounds that neutralize tetanus toxin.

Composition and mechanism of action of antitetanus serum.

Anti-tetanus serum consists of proteins from the blood of a horse that has previously been infected with tetanus. These proteins have active sites that are able to bind to tetanus toxin proteins. As a result, active centers the toxin becomes blocked. For emergency prevention purposes, the serum is injected intramuscularly and within 15-20 minutes its proteins begin to enter the blood. Here they bind to tetanus toxin proteins. As a result, an inactive protein complex is formed, which is destroyed by human immune cells.

Of course, not all toxins bind to serum proteins. Some, bypassing meetings with them, penetrate the nervous system. But this is a small amount. Therefore, when using anti-tetanus serum as an emergency prophylaxis, it leads to the fact that if he gets sick, the tetanus is less severe. Mortality in individuals who were administered tetanus serum is reduced to 10%. And then, most deaths relate to situations where there are chronic diseases and late application for medical care.

Method of introducing serum for the purpose of prevention.

Because tetanus serum is made from animal protein, it may cause allergic reactions. The most dangerous can be anaphylactic shock. But for emergency prophylaxis of tetanus, large enough volumes are needed so that they can cause allergic reactions. Therefore, the introduction of serum (the volume of which is 1 milliliter) is carried out in several stages.

Initially, it is administered at a dilution of 1:100. That is, per unit volume of serum there are 100 units of saline volume. Typically, the total volume is 3 milliliters. That is, tetanus serum accounts for 0.03 milliliters. After this, the person is observed for half an hour. In the absence of allergic reactions, the remaining volume of serum is administered in equal parts (that is, 0.3 milliliters) with an interval of 15 minutes.

Transparent or slightly opalescent, colorless or yellowish liquid without sediment. Represents protein fraction blood serum of horses immunized with tetanus toxoid or toxin, which contains specific immunoglobulins, purified and concentrated by peptic digestion and salt fractionation.

Contains chloroform in a concentration of no more than 0.1%.

Compound

The ampoule contains one prophylactic dose equal to 3000 international units (IU).

Release form

Available in ampoules. The ampoule contains one prophylactic dose. Available complete with purified horse serum diluted 1:100, which is a clear, colorless liquid without sediment.

Antitetanus serum liquid.

Immunological and biological properties

Neutralizes tetanus toxin.

Indications

Urgent specific prevention and treatment of tetanus.

Directions for use and doses

Treatment of tetanus. Antitetanus serum is administered to patients at the earliest as soon as possible from the onset of the disease at a dose of 100,000 - 200,000 IU.

The serum is injected intravenously or into the spinal canal after testing sensitivity to foreign proteins. Depending on the severity of the disease, the administration of serum is repeated until the reflex symptoms disappear.

Emergency prevention of tetanus involves primary surgical treatment wounds and reproduction, if necessary, specific immunity against tetanus.

Emergency specific prophylaxis of tetanus is carried out when:

• injuries with violation of the integrity of the skin and mucous membranes
• frostbite and second, third and fourth degree burns;
• out-of-hospital abortions;
• childbirth outside medical institutions;
• gangrene or tissue necrosis of any type, abscesses;
• animal bites;
• penetrating injuries of the gastrointestinal tract.

For emergency specific prevention tetanus is used:

• AS-anatoxin;
• antitetanus human immunoglobulin(PSCHI)
• in the absence of PSCH - purified concentrated liquid antitetanus serum (PPS).

AS-anatoxin and PSCHI are administered in accordance with the instructions for the use of these drugs.

A scheme for selecting prophylactic agents for emergency specific prophylaxis of tetanus is provided in Appendix No. 1.

Antitetanus serum for the purpose of emergency prevention of tetanus is administered subcutaneously at a dose of 3000 IU.

Side effect

Sometimes the administration of serum is accompanied by various allergic reactions: immediate (immediately after administration of the serum or after a few hours), early (on days 2-6) and late (on the 2nd week and later).

These reactions are manifested by the symptom complex of serum sickness (fever, the appearance of itching and rashes on the skin, joint pain, etc.) and, in in rare cases, anaphylactic shock.

Contraindications

Contraindications for the use of antitetanus serum with therapeutic purpose does not exist.

Contraindications for use specific means emergency tetanus prophylaxis:

1. History hypersensitivity to the appropriate drug.

2. Pregnancy

• in the first half, the administration of AS-anatoxin and PPS is contraindicated;
• in the second half, the administration of PPS is contraindicated.

Features of application

The drug is unsuitable for use if the integrity of the ampoules is damaged or if there is no labeling, the expiration date has expired, if changed physical properties and improper storage.

Before administering anti-tetanus serum, an intradermal test should be performed with purified horse serum diluted 1:100 to test sensitivity to foreign proteins. To take samples, use a syringe with 0.1 ml divisions and a thin needle. The diluted serum is injected intradermally into the flexor surface of the forearm in a volume of 0.1 ml. Observe for 20 minutes.

The test is considered negative if the diameter of the swelling or redness that appears at the injection site is less than 1 cm. The test is considered positive if the swelling or redness reaches a diameter of 1 cm or more.

When negative inside skin test antitetanus serum is administered subcutaneously in an amount of 0.1 ml (use a sterile syringe, close the open ampoule with a sterile napkin). If there is no reaction, after 30 minutes, administer the entire prescribed dose of serum subcutaneously using a sterile syringe (with for preventive purposes), intravenously or into the spinal canal (for therapeutic purposes).

If the intradermal test is positive or if anaphylactic reaction on subcutaneous injection 0.1 ml of antitetanus serum, its further administration is contraindicated. In this case, PSCH should be entered.

Participation in the administration of antitetanus serum to patients,

Administration of tetanus serum and toxoid

Equipment: a ampoules of AS-anatoxin and PSS, beads with alcohol, syringes and needles of the product antishock therapy: 0,1% solution of adrenaline, ice pack, venous tourniquet, desensitizing agents, prednisolone or hydrocortisone

Performing the manipulation:

1. Inform the patient about the upcoming procedure and obtain his consent

2. Before administration, the ampoule with the drug is carefully inspected. The drug cannot be used in following cases:

· If there is no label on the ampoule

· If there is no complete information about the drug on the label

· If there are cracks on the ampoule

If there are unbreakable flakes, sediment or foreign matter

· When expired validity

· In case of improper storage of the drug

3. Wash your hands hygienically

4. Wear sterile gloves

5. Immediately before administration, the ampoule is shaken until a homogeneous suspension is obtained.

6. When opening the ampoule, before and after the incision is made with a file, wipe it with a sterile cotton ball with alcohol. An opened ampoule with AS toxoid or PSS can be stored covered with a sterile napkin for no more than 30 minutes.

7. The drugs are drawn into a syringe from the ampoule using a long needle with a wide bore. Always use a different needle for injection.

8. Before vaccination, 1-2 drops of the contents of the syringe are passed through the needle with which the injection will be performed.

9. When administering AS-anatoxin, the skin at the injection site is disinfected with 70% alcohol, grabbed into the fold with the fingers of the left hand and the needle is inserted into the base of this fold in subcutaneous tissue in the direction from top to bottom. Anatoxin is injected deep under the skin under the lower angle of the scapula (the indicated area is poor in nerves and contains loose fiber)

10. When carrying out emergency prophylaxis of tetanus as prescribed by a doctor, AC-toxoid can be injected into the region where the wound is located (if its localization allows) by subcutaneous injection

11. After administering the drug, the injection site is lubricated with iodine or alcohol and lightly massaged with a sterile ball.

12. Before administering PSS, an intradermal test with horse serum diluted 1:100 is mandatory to determine sensitivity to horse serum proteins (the ampoule is marked in red)

13. To take the sample, use an individual ampoule, as well as sterile syringes with 0.1 ml graduations and a thin needle

14. Serum diluted 1:100 is injected intradermally into the flexor surface of the forearm in a volume of 0.1 ml

15. The reaction is taken into account after 20 minutes. The test is considered negative if the diameter of the swelling or redness at the injection site is less than 1.0 cm. The test is considered positive if the swelling or redness at the injection site reaches a diameter of 1.0 cm or more

16. If the skin test is negative, antitetanus serum (TSS) from an ampoule marked in blue is administered subcutaneously in a volume of 0.1 ml

17. Observe the patient's condition. During this time, the opened ampoule with PSS should be covered with a sterile napkin

18. If there is no reaction, the remaining dose of serum is administered after 30 minutes

19. Each vaccinated person must be provided with medical supervision for an hour after vaccination.

20. The patient should be informed that in the event of an occurrence after vaccination severe malaise accompanied by headache, fever or local reaction with swelling and redness or symptoms of serum sickness, he should seek medical attention immediately

21. Persons with positive reaction for intradermal administration of 0.1 ml of horse serum diluted 1:100 or who had a reaction to subcutaneous administration of 0.1 ml of PSS, further administration of PSS is contraindicated

22. About all cases post-vaccination complications developed after the use of drugs containing tetanus toxoid, as well as after the administration of PSS (shock, serum sickness, diseases nervous system and etc.) Medical staff The health care facility is obliged to urgently notify the State Sanitary and Epidemiological Surveillance Center in the subject Russian Federation

23. Monitor the patient’s condition

Completing the manipulation:

1. Information about the patient and the procedure performed on him emergency prevention tetanus is entered into the register of care for injuries in the section “emergency prevention” indicating the date, name of the administered drugs (AS, PSS), time of administration, dose, series, manufacturer of the drug, as well as the reaction to the administered drug. These data must then be entered into outpatient card, logbook preventive vaccinations, as well as in emergency tetanus prevention logs for injuries

2. The material used is processed according to industry standards regulatory documents on disinfection, pre-sterilization cleaning and sterilization of medical devices.

3. Conduct disinfection and disposal of medical waste in accordance with San.PiN 2.1.7.728-99 “Rules for the collection, storage and disposal of waste from medical institutions”

Introduction anti-rabies drugs

Equipment: rabies vaccine, rabies gamma globulin, syringes, needles, sterile beads with alcohol, solutions of adrenaline (1:1000) or ephedrine (5%), diphenhydramine (2%) or suprastin (2%)

Preparation for manipulation:

1. Explain to the patient the purpose and meaning of the upcoming manipulation and obtain his consent

2. Warn the patient that in order to create lasting immunity and prevent post-vaccination complications, those vaccinated are prohibited from drinking alcoholic beverages during the entire course of vaccinations

3. Warn the patient so that during the course of vaccinations he does not overwork, avoid hypothermia, overheating, and maintain skin hygiene

4. Vaccinations should not be given to victims on an empty stomach.

Performing the manipulation:

· Administration of anti-rabies gamma globulin

1. Wash your hands hygienically

2. Wear sterile gloves

3. Before administering rabies gamma globulin, the body’s sensitivity to horse serum is checked by intradermal testing. To do this, intradermally into the area inner surface 0.1 ml of 1% (1:100) solution of anti-rabies gamma globulin is injected into the forearms. The reaction is taken into account after 20 - 30 minutes. The test is considered negative if the diameter of the papule is up to 1 cm and the redness around it is limited. The test is considered positive if the diameter of the papule exceeds 1 cm and diffuse redness

4. If the test is negative, 0.7 ml of 1% rabies gamma globulin is injected into the subcutaneous tissue of the shoulder

5. If there is no reaction, after 20-30 minutes, the entire prescribed therapeutic and prophylactic dose of whole anti-rabies gamma globulin, heated to 37 degrees, is administered intramuscularly into the upper outer quadrant of the buttock in 2-3 doses with an interval of 10-15 minutes.

6. The entire dose of anti-rabies gamma globulin is administered in one day

7. 24 hours after last injection anti-rabies gamma globulin, a course of vaccinations with anti-rabies vaccine begins

8. If there are vital indications and a positive test or in cases of an anaphylactic reaction to intradermal injection anti-rabies gamma globulin is administered in accordance with special precautions:

· If there is no response to these doses, 0.1 ml of whole anti-rabies gamma globulin is injected into the subcutaneous tissue of the shoulder

· If there is no reaction, after 30 minutes the entire prescribed dose of anti-rabies gamma globulin (warmed to 37 degrees in the thickness of the gluteal muscles) is administered in 2-3 doses with an interval of 10-15 minutes

· When administering gamma globulin, a solution of adrenaline or ephedrine, diphenhydramine or suprastin should always be ready

· Introduction of rabies vaccine

1. The rabies vaccine is administered to the victim with a thin needle in a lying position, slowly, strictly subcutaneously, retreating from midline abdomen by 2-3 fingers at or below the navel at different areas

2. If it is impossible to inject the vaccine into the subcutaneous tissue of the abdomen, for example, due to scars, large infiltrates, in some cases the vaccine can be injected into the subcutaneous tissue in the area of ​​the shoulder blades

3. After administration of the rabies vaccine, the patient is not recommended to stand up for 5 minutes

Completing the manipulation:

1. The used material is processed in accordance with industry regulations on disinfection, pre-sterilization cleaning and sterilization of medical products.

In most countries, including Russia, routine vaccination against tetanus is performed. As a rule, a vaccination against this disease is given together with an injection against diphtheria. In addition, in emergency situations monovaccines are used. Experts note that none of these vaccines provides 100% protection against tetanus. It is important to know about possible side effects tetanus injection. Most often it appears after slight fever. Sometimes there is lethargy, severe weakness, general malaise. A characteristic lump appears at the injection site. All these negative manifestations pass quickly.

In some cases, a tetanus shot may lead to side effect like rhinitis. A person may experience other symptoms consistent with colds. There have been cases of occurrence severe cough paroxysmal in nature. Possible development of serum sickness - allergic disease causing fever, joint pain, increased lymph nodes. Hemorrhages, thrombosis, swelling, itching of the skin, sweating, headache, chills, nausea, vomiting. The disease lasts from several days to 2-3 weeks.

The most serious complications of tetanus vaccination

The most serious side effect is considered to be neurological reactions (convulsions). They are very rare, but the doctor should warn the patient about this before vaccination. It has also been observed in rare cases anaphylactic shock- heavy, life-threatening pathological condition, which refers to allergic reaction immediate type. This condition causes muscle spasm internal organs, a fall blood pressure, the person loses consciousness. Given the possibility of these side effects when administering tetanus serum, the doctor should provide medical supervision to the patient for an hour after the injection.

Severe complications after a tetanus injection are usually observed if the schedule is not followed routine vaccination, as well as when using a vaccine of inadequate quality or if its storage is violated. The tetanus vaccine is given under the shoulder blade; as a rule, a noticeable swelling appears in this place. It is recommended to apply a sterile bandage with Levomekol ointment to it. You can seal this area with a bactericidal adhesive plaster. Also, if possible unpleasant sensations after vaccination, anti-allergy drugs may be prescribed, for example, Suprastin. Anti-tetanus injection is contraindicated

Tetanus is one of the most insidious diseases, which is taken with the utmost seriousness by doctors all over the world. The route of infection with this infection is very simple - the tetanus bacillus can penetrate through the slightest damage to the skin. The causative agent of the disease may be on sewing needle, on manicure tools, even an accidental splinter can cause tetanus infection. In case of accidental injury or tissue damage, it is necessary to go to the emergency room, where the patient will be urgently administered anti-tetanus serum. Let's look at what the instructions are this drug when after an injury you need to get vaccinated against tetanus and whether vaccination can protect against the infectious agent.

Tetanus serum - principle of action

Tetanus vaccine is produced from a purified and concentrated protein fraction of horse blood serum immunized with tetanus toxoid.

5 things you need to know about the tetanus vaccine.

• The drug according to its own biological properties created for neutralization of tetanus toxin.
• The instructions that accompany the tetanus serum state that according to the treatment regimen, the drug must be administered after the first signs of the disease appear or in case of injury in extremely early dates . Can be expensive every hour to prevent irreversible and severe consequences for the human body.

Important! Incubation period The average duration of illness is 7-10 days, but cases of duration are known latent period tetanus up to several months. It makes sense to carry out immunoprophylaxis in the form of vaccination up to and including the 20th day from the moment of injury, trauma or tissue damage.

• The vaccine is administered intravenously or into the spinal canal, after primary processing wounds and testing the sensitivity of the patient’s body to foreign protein. To do this, an intradermal test is performed, the result of which is assessed after 20 minutes. If the diameter of the redness at the sample site is less than 1 cm, the test is negative; The serum is administered in full dose. Redness of more than 1 cm or the occurrence of an anaphylactic reaction are a contraindication for the administration of anti-tetanus serum. After a positive test, the patient is administered PSHI (anti-tetanus human immunoglobulin).
• Vaccine dose administered for emergency prevention of the disease is 100,000-200,000 IU.
• When reflex spasms occur or other manifestations of the disease (judging by the severity), the tetanus serum is intended to be administered repeatedly at certain intervals until they completely disappear.

Emergency immunoprophylaxis for tetanus

The concept of “emergency” in this context means only one thing - that the vaccine is given immediately after the victim goes to the emergency room. But, contrary to popular belief that an anti-tetanus injection is given for any injury, this does not always happen.

Antitetanus serum is intended for emergency administration in the following cases:

• damage to mucous membranes, tissues, skin (trauma, wounds);
• chemical, thermal burns or after tissue frostbite, starting from the second degree of severity and above;
• out-of-hospital births or abortions performed outside medical institutions (home births are no exception);
• gangrene/tissue necrosis;
• long-term abscesses;
• animal bites of any kind.

An infectious disease specialist prescribes emergency immunoprophylaxis. Also, the instructions for prescribing the drug against tetanus state that the decision should be made differentiated, i.e. the nature of the injury, the patient’s vaccination certificate or other documentary evidence on preventive vaccinations.

Emergency prophylaxis for tetanus is NOT carried out:

• children who have a document confirming that they have undergone (in accordance with the child’s age) routine preventive vaccinations;
• patients who have a document confirming a complete course of immunization (valid for no more than 5 years);
• patients who have a protective titer of tetanus antitoxin in the blood serum according to the results of a preliminary test (above 1:160 according to RPGA).

Contraindications to tetanus serum

According to official data, the drug described above has no contraindications, with the exception of the result of an intradermal test. But there have been recorded cases of post-vaccination side effects after injections of this vaccine:

• local allergic reaction;
• increased body temperature;
• pain at the injection site;
• muscle weakness;
• fatigue of the body, irritability.

All side effects from serum are temporary and do not pose a threat to health. The ailments disappear without consequences 2-3 days after vaccination. For longer-lasting complaints, you should consult a doctor.

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