I discern a thread coming out of these discussions. We simply do not know what the risk of an individual of any age is of contracting the clinical
disease caused by clostridium tetanii organisms being inoculated subcutaneously. That means that we may need to change our current
Balint-opportunistic approach to tetanus immunisation to one based on antibody levels. It is currently eminently possible but expensive to
determine the tetanus antibody level; it was done a while ago for a patient of mine who claimed to be allergic to 'tetanus serum' (probably a horse
protein, in fact) who was willing to be vaccinated under controlled conditions ( ie sitting in our department for an hour or so afterwards, just in case
of anaphylactic/oid reaction) if her levels were low. They were indeed, and responded satisfactorily to a single booster injection.
Doctors check antibody levels routinely for hepatitis B and fairly often for rubella. There are still a lot of elderly people out there who may have had
a tetanus jab or two a few years ago by a GP after a well person payment who think they are immune and are not. There may be quite a large cohort
of children coming up who have missed one or several injections and may not be adequately protected.
It seems to me that we need to undertake research into this question to inform the debate. After that, sensible informed risk-based recommendations
can be formulated. I don't think we should be administering "routine" vaccines of any sort, though.
Best wishes,
Rowley Cottingham
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http://www.emergencyunit.com
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