Tetanus incidence and immunity in Poland

Tetanus IgG antibody levels in children aged 12 to 47 months in Turkey

Tetanus is a serious disease with high mortality, which is very difficult to treat but can be prevented easily by vaccination. The number of tetanus cases reported in Turkey was 42 in 1996 and 51 in 1997. This study was carried out on children aged 12 to 47 months who have vaccination cards in the No. l Health Centre in Batikent district in Ankara, Turkey. Forty-one of the children had received 3 doses (Group 1) of tetanus vaccine, and 47 of them had received 4 doses of the vaccine (Group 2). Anti-toxoid IgG antibody in blood sera was quantified by using the enzyme-linked immunosorbent assay technique. In Group 1, antibody levels more than 0.01 IU/mL were found in 47%, 43%, and 45% of blood sera of children aged 12 to 23 months, 24 to 35 months, and 36 to 47 months, respectively. These rates in Group 2 were found to be 91%, 88%, and 60%, respectively. The protective antibody response (>1 IU/mL) was found to be higher for children in Group 2 than in Group 1, but both rates declined with age. Checking immunization status periodically and giving vaccine doses as required are essential to increase the antibody response. Further, it is a must in developing countries where vaccination efforts are hindered by cold-chain problems, underoptimum application practice, and high prevalence of concomitant infections.

A population-based study on tetanus antitoxin levels in The Netherlands

We assessed the tetanus immunity of the general Dutch population and of religious groups refusing vaccination by means of population-based study to evaluate the effect of tetanus vaccination. More than 95% of those born after the introduction of routine vaccination had tetanus antitoxin levels above the minimum protective level. After the sixth vaccination, a fall in tetanus antitoxin levels occurred. Nevertheless, immunisation in accordance with the routine programme most likely induces protection for much longer than two decades. Not only many members of religious groups who refuse vaccination, but also many adults born before the introduction of vaccination lack tetanus immunity. These cohorts might benefit most from (re)vaccination.

Tetanus immunity in an older Australian population

OBJECTIVE

To evaluate the effectiveness in older Australians of the current tetanus vaccination program.

DESIGN

A cross-sectional survey of tetanus immunity (enzyme immunoassay of serum samples) in an older population in New South Wales. Self-reported history of tetanus vaccination was compared with serologically measured immunity.

PARTICIPANTS

430 randomly selected adults, 49 years of age and older, from the Blue Mountains Eye Study population.

RESULTS

Fifty-two per cent (95% confidence interval [CI], 47%-57%) of adults 49 years of age and older had protective levels of tetanus antitoxin ( > 0.15 IU/mL). There was a significant decline in the prevalence of immunity with increasing age (chi 2 for linear trend, P = 0.036), and women were less likely to be immune regardless of their age (Mantel-Haenszel weighted odds ratio, 0.65; CI, 0.43-0.92). Thirty-five per cent (95% CI, 31%-40%) of all participants reported that they had been vaccinated in the preceding 10 years. Although self-reported tetanus vaccination history was associated with tetanus immunity, it was neither sensitive nor specific as a test for immunity.

CONCLUSIONS

About half the adults 49 years of age and older in the Blue Mountains area of New South Wales do not have protective levels of tetanus antitoxin because of inadequate vaccination coverage in this age group. Vaccination history is not a reliable indicator of tetanus immunity and a system is needed for accurate recording of adult vaccination.