A National Study of Tetanus Vaccine Knowledge, Receipt and Acceptance Among Emergency Department Patients

OBJECTIVE: The Tetanus, Diphtheria, Pertussis (Tdap, "tetanus") vaccine is recommended for adults every 10 years. In a national sample of adult emergency department (ED) patients, we sought to determine (1) knowledge and up-to-date status of the tetanus vaccine; (2) reasons for nonreceipt of the vaccine; (3) vaccine acceptability if offered in the ED; and (4) reasons for nonacceptance in the ED if offered. METHODS: This was a cross-sectional survey study among non-critically ill adults at 10 US EDs, asking questions about knowledge, receipt, and acceptability of the tetanus vaccine. Vaccine receipt was determined by self-report. Aggregate responses are reported as descriptive statistics. Logistic regression modeling was performed, and data are presented as adjusted odds ratios (aOR) with 95% confidence intervals (CIs). RESULTS: Of 4326 patients approached, 3285 (75.9%) agreed to participate, and 5 were excluded because of incomplete responses. Among 3280 participants, 13.4% had not heard of the vaccine; and 58.0% were not up-to-date. Factors associated with not being up-to-date included age 34-48 (aOR 0.65; 95% CI 0.53-0.81), African American race (aOR 1.46; 95% CI 1.19-1.79), no primary care doctor (aOR 1.29; 95% CI 1.04-1.61) and no insurance (aOR 1.86; 95% CI 1.36-2.56). Among participants not up-to-date, 21.6% would accept it during their ED visit. Primary reasons for nonacceptance were needing more information, concerns about side effects, and preference to get it from their doctor. CONCLUSIONS: Over half of adult ED patients are not up-to-date on the tetanus vaccine but only one-fifth would accept it if offered during an ED visit. ED-centered efforts to increase uptake should provide messaging to address vaccine hesitancy.