I'd agree individuals often have a very poor memory regarding their last
At Lancaster the computer prints out on the card the last time the patient
had a booster (at Lancaster). Patients are often many years out!
----- Original Message -----
From: "Max Hills" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Saturday, May 22, 2004 8:24 PM
Subject: Re: Tetanus
> 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
> Porter JD. Perkin MA. Corbel MJ. Farrington CP. Watkins JT. Begg NT.
> Public Health Laboratory Service, Communicable Disease Surveillance
> Centre, London, UK.
> Lack of early antitoxin response to tetanus booster.
> Vaccine. 10(5):334-6, 1992.
> 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
> 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
> > 35 yr old who had had 5 boosters last one being as a teenager (full
> > 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
> > 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
> > 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
> > other countries where primary vaccination is given in the first years
> > of life.