A problem is that we are relying on individuals' recall regarding
vaccines they have received. I conducted a questionnaire which was
deployed in the waiting room of the Trinity College Dublin Student
Health Service. The Student Health service is frequented mainly by
students of the University so the population studied was young
(18-52yrs, mean22.71yrs) and (hopefully!) well-educated. The
questionnaire was voluntary and we received 228 responses.
With regard to tetanus vaccination status, 19.7% could not remember
whether they had received tetanus vaccine or booster in the last 10
years. 13.6% of respondents could not remember whether they had
received Meningitis C vaccine or not, despite this vaccination programme
having occurred in the preceding two years in a nationwide campaign. As
the list will know, no vaccine exists for Hep C, despite this 19.7% of
respondents believed they were protected against this infectious
disease. (A number of respondents who were studying medicine stated that
they were covered and course of study had no influence on how
respondents answered this question). These and other results suggested
that a large number of patients really don't know their true vaccination
status (and that many don't know that they don't know!)
This study was part of an overall project which examined the utility of
an internet based vaccination registry, which would allow doctors to
update the current vaccine status of patients online from any
internet-connected computer, using a simple web interface.
Further information is available on request.
Max Hills.
Emergency Medicine Trainee.
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Ray McGlone
Sent: 22 May 2004 15:38
To: [log in to unmask]
Subject: Re: Tetanus
Authors
Porter JD. Perkin MA. Corbel MJ. Farrington CP. Watkins JT. Begg NT.
Institution
Public Health Laboratory Service, Communicable Disease Surveillance
Centre, London, UK.
Title
Lack of early antitoxin response to tetanus booster.
Source
Vaccine. 10(5):334-6, 1992.
Abstract
Tetanus immune globulin (TIG) continues to be recommended in persons
with tetanus-prone wounds who have incomplete or unknown tetanus
immunization status. The aim of this study was to determine whether,
following a booster dose of tetanus toxoid in adults who had not been
immunized in the previous 10 years, there was an antitoxin response to
tetanus toxoid booster within 4 days. Thirty-one adults were
investigated, baseline levels for tetanus antitoxin assayed using an
ELISA technique, and an injection of adsorbed tetanus toxoid (0.5 ml)
given. Blood samples for tetanus antitoxin levels were taken at daily
intervals for the 4 days following immunization. Tetanus boosters
following the primary course but before the present study did not
significantly increase the levels of pre-study tetanus antitoxin and
following the study booster there was no difference between the preboost
levels and the levels on days 1 to 4. This finding indicates that the
present recommendations for the use of TIG in tetanus-prone wounds are
appropriate.
Putting these two papers together it would seem that a booster given to
a patient following a previous completed primary immunisation will get
an adequate antibody levels by 4 days but if the immunisation is
incomplete or unknown then a booster won't give adequate cover.
Ray McGlone
----- Original Message -----
From: "Ray McGlone" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Friday, May 21, 2004 11:34 PM
Subject: Tetanus
> I was wondering what people were doing on the ground regarding tetanus
> immunisation. We hadn't had a tetanus case in our area for over 20
> years until one case last year and now another one this year. The last
> case was
a
> 35 yr old who had had 5 boosters last one being as a teenager (full
course),
> the person developed tetanus about two weeks after a thorn injury
> whilst gardening. The person did not attend A&E at the time of the
> injury.
>
> But on the current advice (enclosed) she would not have been offered a
> tetanus booster if she had attended A&E. I must admit that I still
> offer a booster if the wound is "tetanus prone" if they have not had a
> booster within 10 years. In the study below adequate circulating
> levels of
antitoxin
> were acheived within 4 days of the booster.
>
> What do other people do?
>
> Ray McGlone
> A&E Lancaster
>
> Authors
> Simonsen O. Kjeldsen K. Heron I.
>
> Title
> Immunity against tetanus and effect of revaccination 25-30 years after
> primary vaccination.
>
> Source
> Lancet. 2(8414):1240-2, 1984 Dec 1.
>
> Local Messages
> Held at BMA Library
>
> Abstract
> Fall off in tetanus immunity and the effect of late revaccination were
> investigated in a randomly selected group of Danes aged 25-30. Routine
> reinforcing doses of tetanus toxoid are not customary in Denmark
> except at injury and when there are certain occupational risks. 11% of
> the total
group
> of 418 had antitoxin titres below that required for protection (ie,
> less than 0.01 IU/ml, determined by neutralisation technique). In
> those who had received only primary vaccination an exponential fall
> off in immunity was seen, and 25-30 years after primary vaccination,
> 28% had serum antitoxin concentrations below the level of protection.
> Up to 30 years after primary vaccination, one reinforcing dose of
> tetanus toxoid adsorbed by aluminium hydroxide was sufficient to
> induce protective titres of antitoxin. There were no serious
> side-effects and it was concluded that routine reinforcing doses of
> tetanus toxoid should be given before the age of 20 in Denmark
and
> other countries where primary vaccination is given in the first years
> of life.
>
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