Open Access Highly Accessed Research article

The use of tetanus post-exposure prophylaxis guidelines by general practitioners and emergency departments in the Netherlands: a cross-sectional questionnaire study

Robine Donken1*, Nicoline van der Maas1, Corien Swaan1, Tjerk Wiersma2, Margreet te Wierik1, Susan Hahné1 and Hester de Melker1

Author Affiliations

1 Centre for Infectious Disease Control, National Institute for Public Health and the Environment, P.O. Box 1 (postbak 75), 3720 BA Bilthoven, The Netherlands

2 Dutch College of General Practitioners, Utrecht, The Netherlands

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BMC Family Practice 2014, 15:112  doi:10.1186/1471-2296-15-112

Published: 9 June 2014



The Dutch National Immunisation Programme includes six tetanus toxoid (TT) vaccinations and reaches a high rate of vaccination coverage. In the Netherlands, several guidelines related to tetanus post-exposure prophylaxis (T-PEP) are in place. In 2003, the Dutch Health Council (HC) reviewed the use of T-PEP. The aim of this study is to evaluate whether the HC recommendations have been implemented.


We asked 178 Dutch General Practitioner (GP) offices and 60 Emergency Departments (EDs) to participate in a cross-sectional questionnaire study and requested that participating facilities send in the T-PEP guidelines adopted by their practice. The differences, based on categories mentioned in the HC recommendations, between GPs and EDs and the type of T-PEP guidelines adopted were assessed.


The response rates for the GPs and EDs were 38% (n = 67) and 70% (n = 42), respectively. 98% percent (n = 107) of the participants reported having T-PEP guidelines. Of the guidelines described in the survey responses, 28% (n = 23; EDs 41%, GPs 21%) were consistent with the HC-recommendations, 36% (n = 29; EDs 7%, GPs 52%) adhered to the guidelines of the College of GPs (CGP), which restricts the use of T-PEP to tetanus prone wounds but for these wounds is in line with the recommendations of the HC. The remaining 36% had adopted other guidelines, most of which can lead to over-prescription of T-PEP. Information on T-PEP was lacking in patients with higher risk vaccination histories.


Almost all participants have adopted T-PEP guidelines. Strict adherence to the HC recommendations is low. More than half of GPs have adopted the more restrictive CGP-guideline, which limits T-PEP to tetanus prone wounds.

Tetanus; Post-exposure prophylaxis; Guidelines; Health council; General practitioners; Emergency departments