Letter to the Editor

Dear authors,

We read your September 2015 article¹ with interest. You investigated the epidemiology of injuries caused by mammals treated in emergency departments. This contribution regarding rabies prophylaxis and antibiotic treatment in animal bites is a significant issue. We want to draw attention to an important point that was not mentioned in the article.

Animal bites are usually considered dirty wounds.  Therefore, every patient exposed to an animal bite should be evaluated for the requirement of tetanus prophylaxis, which is also an important component of postexposure rabies prophylaxis.^2,3 We could not see any data in the article regarding tetanus prophylaxis. We think that this important point should be clarified.

Hasan Tahsin Gözdaş, MD¹ and Mustafa Hatipoglu, MD^2
1Department of Infectious Diseases and Clinical Microbiology, Dr. Münif İslamoğlu Kastamonu State Hospital, Kastamonu, Turkey; and ²Department of Infectious Diseases and Clinical Microbiology, Çanakkale Military Hospital, Çanakkale, Turkey

Dear authors,

We agree with you that tetanus prophylaxis is an important component of postexposure prophylaxis against infection following mammal-related injuries. Because the vast majority of patients do not have a vaccine record when presenting to the emergency ward and because rapid testing is not recommended in France pending results of evaluation surveys,⁴ we only have declarative data on the vaccination status of the patients investigated in our survey (Table 1). Data was also missing in a significant proportion of medical records. For these reasons, we decided not to include it in our paper. Overall, only 43% of patients had documented up-to-date vaccination against tetanus and consequently 56% received a booster vaccine injection at the emergency unit. Only 1% of patients received tetanus immune globulin, although at least 35% should have received it according to the French recommendations at the time of the study.⁵ No case of tetanus was observed in our cohort. From 2008–2011, 36 cases of tetanus were recorded in France, of which 1 resulted from a rat bite and 1 from a cat scratch.⁶

In conclusion, we found that tetanus immune globulin was underused by practitioners at the emergency ward in Marseille, France, which may be due to the relative complexity of French recommendations at the time this survey was conducted, as evidenced in other French studies.^7,8

Philippe Gautret, MD, PhD
CHU Nord, Chemin des Bourrely
13915 Marseille, France