Integrating non-neonatal tetanus vaccination into an emergency department rabies PEP clinic: Real-world workload, documentation gaps, and VAERS-informed observation priorities

Animal-bite and scratch visits to the emergency department (ED) often require time-sensitive decisions on rabies post-exposure prophylaxis (PEP) alongside tetanus prevention. In China, recent national standards and local implementation programs have framed non-neonatal tetanus prevention as an integrated medical–public health service model, yet integrated workflows and structured documentation remain uncommon in many tertiary hospitals. We reviewed patients presenting for their first recorded exposure to a dedicated ED rabies PEP clinic (8 Oct 2022–31 Oct 2025; n = 3,365) to describe real-world encounter characteristics and quantify implementation-relevant workload. Grade III exposures accounted for 73.6% of presentations, and 93.1% of patients presented on the same day. While grade III encounters form a practical priority subgroup for tetanus management, grade II/III encounters represented 99.4% of visits, indicating that tetanus immunization-history review and wound tetanus-risk documentation would need to be routine steps for nearly all PEP encounters. However, tetanus-related elements (immunization history, Td/Tdap/TT vaccination, tetanus immunoglobulin/antitoxin use) were not captured in structured registry fields, and Td/Tdap/TT vaccination is not routinely available in our ED clinic workflow, highlighting a quality improvement opportunity for standardized implementation. To provide external pharmacovigilance context in the absence of local coadministration safety data, we summarized adult VAERS reports listing both rabies vaccine and Td/Tdap/TT in 2022–2025 (n = 9; serious reports 0/9) and explored predefined disproportionality signals in 2006–2025. In sensitivity analyses, syncope and hypersensitivity showed increased reporting odds in reports listing both vaccines compared with rabies-only reports. These VAERS findings are presented as hypothesis-generating only: they identify potential event categories that may warrant awareness and documentation if multiple vaccines are administered during one encounter, but they do not confirm same-day administration, estimate incidence, or support causal inference.