The tetanus article needs some updating – I’d say by a doc. Why do we who ride need to be
concerned about tetanus? Combined with the skin part are a general sports medicine that with a
few paragraphs fit with the horse community. If you would like, I can get some horse skin photos
from somewhere – would need to involve a discussion of hair coats.
Pre-exposure vaccination
Tetanus is easily preventable through vaccination. All children should have a series of five doses
of DTaP, a combined vaccine that offers protection against diphtheria, tetanus, and pertussis,
before the age of seven, according to the Centers for Disease Control and Prevention's national
immunization guidelines, the Advisory Committee on Immunization Practices, the Committee on
Infectious Diseases of the American Academy of Pediatrics, and the American Academy of
Family Physicians. Children will not be admitted to school without proof of this and other
immunizations.
The DTaP (diptheria, tetanus, accellular pertussis) vaccine should be given at ages two months,
four months, six months, 15 to 18 months, and four to six years. DTaP is the preferred vaccine
for children up to the age of seven in the United States; it has fewer side effects than DTP and
can be used to complete a vaccination schedule begun with DTP. DTaP was first approved by the
Food and Drug Administration (FDA) in September 1996. In December 1996, it was approved
for use in infants. Between the ages of 11 and 13, children should have a booster for diphtheria
and tetanus, called Td.
Adults should have a Td booster every 10 years. Statistics from the Centers for Disease Control
and Prevention (CDC) show that fewer than half of Americans 60 years of age and older have
antibodies against tetanus. The CDC suggests adults may be revaccinated at mid-decade
birthdays (for example, 45, 55). Adults who have never been vaccinated against tetanus should
get a series of three injections of Td over six to 12 months and then follow the 10-year booster
shot schedule.
Side effects of the tetanus vaccine are minor: soreness, redness, or swelling at the site of the
injection that appear anytime from a few hours to two days after the
vaccination and go away in a day or two. Rare but serious side effects that require immediate
treatment by a doctor are serious allergic reactions or deep, aching pain and muscle wasting in
the upper arms. These symptoms could start from two days to four weeks after the shot and could
continue for months.
In early 2001, a shortage of the tetanus vaccine became evident after the pharmaceutical
company Wyeth-Ayerst Laboratories decided to stop production of the tetanus vaccine, leaving
Aventis-Pasteur as the sole manufacturer of the vaccine. As a result, hospitals were provided
with only a minimal amount of the drug on a weekly basis—enough to vaccinate patients with
potentially infected wounds and other priority cases. Despite stepped-up production efforts on
the part of the manufacturer, however, a spokesperson for Aventis-Pasteur predicted that the
shortage would last until the end of 2001, as the vaccine takes 11 months to produce.
Post-exposure care
Keeping wounds and scratches clean is important in preventing infection. Since this organism
grows only in the absence of oxygen, wounds must be adequately cleaned of dead tissue and
foreign substances. Run cool water over the wound and wash it with a mild soap. Dry it with a
clean cloth or sterile gauze. To help prevent infection, apply an antibiotic cream or ointment and
cover the wound with a bandage. The longer a wound takes to heal, the greater the chance of
infection. If the wound doesn't heal, or if it is red, warm, drains, or swells, consult a doctor.
Following a wound, to produce rapid levels of circulating antibody, a doctor may administer a
specific antitoxin (human tetanus immune globulin, TIG) if the individual does not have an
adequate history of immunization. The antitoxin is given at the same sitting as a dose of vaccine
but at separate sites. Some individuals will report a history of significant allergy to "tetanus
shots." In most cases, this occurred in the remote past and was probably due to the previous use
of antitoxin derived from horse serum.
— Lori De Milto
Skin Infection May Be MRSA
By Lindsay Barton
One of the keys to preventing the spread of the antibiotic-resistant skin infection or
"super bug" known as methicillin-resistant staphylococcus aureus ("MRSA") is proper
identification and treatment of suspicious skin lesions. The infection often looks like an
ordinary skin wound or boil, which may look harmless but rapidly develops into large
abscesses within 24 to 48 hours. Diagnosis is difficult. Treatment with penicillin-related
antibiotics is ineffective.
Coaches, parents, and athletes should therefore be on the lookout for:
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Skin infections that may appear as pustules or boils at the site of visible skin
trauma, such as cuts and abrasions, and areas of the body covered by hair (e.g.
back of neck, groin, buttock, armpit, beard area);
Fever;
Pus or other drainage;
Swelling; and/or
Pain
MRSA: Suspicious Skin Infections
Skin abscess:
undefined
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localized collection of pus associated with tissue destruction
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can become superinfected
body shaving, especially areas covered by clothing, predisposes to infection
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Abscess that develops from staph folliculitis
Carbunkle:
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series of subcutaneous abscesses
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drain through multiple hair follicles
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looks like a “spider bite”
Cellulitis:
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Infection of the skin surface without pus formation
Impetigo:
"It's important for coaches and parents to be aware MRSA might be a cause of skin problems in
children," Dr. Dan Jernigan, a CDC medical epidemiologist, told the Associated Press.
Treatment
If your child has a suspicious skin/soft tissue infection, take him to the doctor, who should obtain
a culture of the lesion, which will guide selection of the appropriate antibiotic.
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The primary treatment of an abscess or purulent skin lesion (one discharging pus) is
incision and drainage.
Although this is usually adequate to clear up the infection, it is sometimes insufficient, in
which case a course of antibiotics will be necessary.
Antibiotic therapy may include clindamycin, trimethoprim-sulfamethoxazole (TMPSMX, Septra, Bactrim), and tetracycline.
Using antibiotics following the incision and drainage of the lesion is left to the discretion
of the treating physician based on the size of the lesion, cellulitis, age of the patient,
fever, signs of systemic infection, and the presence and effect of other disorders or
diseases.
Other prevention tips
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Clean and cover all wounds. If an athlete's skin is injured, it should be
washed immediately with soap and warm water, dried and covered with a clean
bandage. If a wound cannot be covered adequately, the program should consider
excluding players with potentially infectious skin lesions from practice or
competition until the lesions are healed or can be covered adequately;
Exlude infected athletes from participation. Athletes with evidence of spreading,
cellulitis or systemic infections (i.e. fever and chills) should be excluded from sports
participation. Athletes with contained infections but no systemic symptoms may be able
to participate on a case-by-case basis.
Anti-bacterial ointment. Clean any cut with soap and water and then
applying a topical over-the-counter "maximum strength" or "triple antibiotic"
anti-bacterial ointment. While there are, as of yet, no peer-reviewed clinical
studies to confirm the results, a laboratory study conducted at the College of
Pharmacy at Oregon State University (OSU), which was presented at a December
2007 meeting of the American Society of Health-System Pharmacists, found that
an ointment containing benzethonium chloride with tea tree and white thyme oil
worked best against all four tested MRSA strains, while ointments containing
neomycin, polymyxin, and gramicidin also had some antibacterial effectiveness.
Source: Centers for Disease Control; Weber, Kathleen. "Community-Associated MethicillinResistant Staphylococcus aureus Infections in the Athlete." Sports Health: A Multidisciplinary
Approach 1 (2009): 405-410.
Updated November 9, 2009