Seroprevalence of Tetanus Antibodies Among Adults Older Than 65 Years,☆☆,,★★

Presented at the Society for Academic Emergency Medicine Annual Meeting, San Antonio, May 1995.
https://doi.org/10.1016/S0196-0644(96)70132-4Get rights and content

Abstract

Study objective: To define the extent of immunity against tetanus among patients older than 65 years of age by measuring antitetanus antibody levels. Methods: A convenience sample of 129 patients from an urban comprehensive care geriatric center was studied. Serum was obtained and enzyme-linked immunosorbent assay (ELISA) testing performed. Twenty health care providers, aged 25 to 40 years, were tested for comparison. Results: In 64 (50%) of 129 study patients, antitetanus antibody levels did not reach protective levels. Fifty-four (59%) of 92 women and 10 (27%) of 37 men did not have adequate titers. All 20 health care workers had protective titers. Conclusion: Elderly patients are substantially less likely than young individuals to have adequate immunity against tetanus. Emergency physicians must take this into consideration when evaluating tetanus immunization status in injured elderly patients. [Alagappan K, Rennie W, Kwiatkowski T, Falck J, Silverstone F, Silverman R: Seroprevalence of tetanus antibodies among adults older than 65 years. Ann Emerg Med July 1996;28:18-21.]

Section snippets

INTRODUCTION

More than 1 million deaths per year worldwide are attributable to tetanus. Most cases occur in developing countries, with more than 50% in the neonatal population.1 However, with adequate immunization practices, tetanus is a preventable disease. Tetanus immunization became widely available to the U.S. civilian population after successful immunization programs in the military during World Wars I and II. This has markedly decreased the number of tetanus cases as an increasing number of children

MATERIALS AND METHODS

A convenience sample of 129 patients aged 65 years or older was recruited from a large urban comprehensive geriatric care center; 118 were outpatients and 11 were admitted to the inpatient unit from the outpatient clinic. All patients attending the clinic from November 15, 1994, through December 22, 1994, and from March 24, 1995, through April 10, 1995, were eligible for the study. Only patients who declined to participate were excluded. This center provides a broad range of medical and social

RESULTS

The mean age for all participants was 78 years (range, 65 to 97 years); there were 92 female (71%) and 37 male (29%) patients. Of the study population, 64 (50%) did not have adequate antibody titers to tetanus toxin (95% confidence interval [CI], 41% to 59%; Figure 1). The mean age of patients without protective titers was the same as for those with protective titers (78.5 versus 78.0 years, respectively, P=.58). Among the female patients, 54 (59%) did not have adequate titers, compared with 10

DISCUSSION

Although a rare disease in the United States, tetanus is still a public health concern. With recognition of the characteristics of populations at risk, immunization practices can be directed accordingly. The results of this study, the first to use the most recently revised standards for measurement of tetanus antibody titers, indicate that a significant percentage of elderly patients do not have protective levels of tetanus antibodies. Although other studies have reached the same conclusion in

Acknowledgements

The authors thank Dr Phillip McPherson, Dr Vibhu Narang, and Dr Helen Weiss.

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Cited by (0)

From the Department of Emergency Medicine, Long Island Jewish Medical Center*, and the Department of Geriatric Medicine, Parker Jewish Geriatric Center, New Hyde Park, and the Albert Einstein College of Medicine, Bronx, New York.

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Partially supported by a grant from ENZO Labs of Farmingdale, Long Island, New York.

Reprints not available from the authors.

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Reprint no. 47/1/73678

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