Tetanus References ================== [Lindemayr H, Drobil M, Ebner H [Reactions to vaccinations against tetanus and tick-borne encephalitis caused by merthiolate (thiomersal)] Hautarzt 1984 Apr;35(4):192-6.] ABSTRACT: Thirty patients with suspected adverse reactions to tetanus- or tick-borne encephalitis-vaccines were subjected to allergy tests. In 8 of 30 patients epicutaneous and/or intracutaneous tests with merthiolate were positive. Testing anorganic mercury, formaldehyde, aluminium hydroxide, gentamycin and egg white (i.c. and RAST), no positive reactions were found. After vaccination - prior to testing - merthiolate - positive patients had suffered from local inflammatory reactions at the injection site, fever and lymphadenopathy (four patients), urticarial (three patients) or lichenoid exanthemas (one patient). Reviewing the literature it is suggested that alternatively merthiolate-free vaccines be provided for sensitized individuals. [Nielsen AO, Kaaber K, Veien NK [Aluminum allergy caused by DTP vaccine] Hudklinikken, Herning. Ugeskr Laeger 1992 Jun 29;154(27):1900-1.] ABSTRACT: All children referred to two private dermatological practices from 1 Jan. 1985 to 31 Dec. 1990 who had pruritus and subcutaneous infiltrates in the areas of immunization with Di-Te-Pol vaccine were patch tested with a Finn Chamber or with 2% aqueous aluminium chloride. Di-Te-Pol vaccine contains aluminium hydroxide. Contact allergy to aluminium was demonstrated in 32 children (20 girls and 12 boys). Of the three patch test methods used, testing with 2% AlCl3 occluded with a Finn Chamber proved to be the most sensitive. Immunization of children who have been shown to be allergic to aluminium should be carried out with vaccines which do not contain aluminium. [Nivedita N. Severe tetanus--in spite of tetanus toxoid. Med J Malaysia, 49: 1, 1994 Mar, 105-7.] A 66-year-old man sustained an injury to his right foot while gardening. Despite receiving tetanus toxoid one hour later and adequate wound toilet, he developed severe tetanus complicated with autonomic dysfunction six days later. He died 20 days after admission. This case shows that tetanus toxoid alone may not be sufficient to prevent tetanus in wounded patients. Careful consideration must be given to the immune status of the patient and to the nature of the wound sustained. Incompletely immunised patients or patients with unknown immune status who sustain a tetanus prone wound should be protected with both tetanus toxoid and tetanus immunoglobulin. [Murphy NM, Olney DB, Brakenbury PH. Objective verification of tetanus immune status in an apparently non-immune population.Br J Clin Pract, 48: 1, 1994 Jan-Feb, 8-9.] Patients who are not known to be immunised to tetanus are considered to be non-immune. The appropriate treatment is the commencement of active immunisation with a course of three tetanus toxoid inoculations; if the wound is considered to be tetanus-prone, 250 IU of human anti-tetanus immunoglobulin is given concurrently. This study determined the true immune status of 166 patients who were considered to be non-immune on the basis of the available history. The majority (90 of 166) had protective levels of immunoglobulin (greater than 0.06 IU/ml) and further treatment was not indicated. Only two patients were non-immune. The remainder had protective levels (between 0.01 and 0.06 IU/ml) and required a tetanus toxoid booster. [Bowen V, Johnson J, Boyle J, Snelling CF. Tetanus--a continuing problem in minor injuries. Can J Surg, 31: 1, 1988 Jan, 7-9.] Tetanus is rare in North America because of highly effective specific immunization programs. Nevertheless, 15 patients with generalized tetanus were treated at the Vancouver General Hospital over a 20-year period; 10 of them were over 50 years of age. Two patients had no injury and 12 had suffered only minor wounds. None had received previous immunization and, even after wounding, prophylaxis was unsatisfactory in all cases. Nine patients required intensive care and two died. Positive cultures were obtained in only two cases. Four recommendations are made to prevent tetanus: (a) all wounds should be considered "tetanus-prone", (b) an accurate history of immunization should be obtained, (c) more attention should be given to prophylaxis at the time of injury and (d) patients should record vaccinations. [Porter JD, Perkin MA, Corbel MJ, Farrington CP, Watkins JT, Begg NT. Lack of early antitoxin response to tetanus booster. Vaccine 1992;10(5):334-6.] 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. [Jacobs RL; Lowe RS; Lanier BQ. Adverse reactions to tetanus toxoid. JAMA 1982 Jan 1;247(1):40-2. ABSTRACT: A retrospective review of 740 charts of patients with a history of adverse reaction to tetanus toxoid immunization was undertaken. The most common reactions, by history, were local edema and tenderness (33%), fever (15%), and anaphylactoid response (33%). Three patients who had a vesicular eruption at the immunization site were found to have delayed hypersensitivity to mercury. Thirty percent of the patients had received tetanus toxoid within one year and 55% within five years of evaluation. Reactive responses to immediate skin tests were exceedingly rare (less than 1%). None of the challenge patients suffered an adverse reaction.