Tetanus immunization status and immunologic response to a booster in an emergency department geriatric population
✍ Scribed by Annie B Gareau; R.J. Eby; B.A. McLellan; D.R. Williams
- Publisher
- Elsevier Science
- Year
- 1990
- Tongue
- English
- Weight
- 571 KB
- Volume
- 19
- Category
- Article
- ISSN
- 1097-6760
No coin nor oath required. For personal study only.
✦ Synopsis
Study objectives: Although effective procedures for the prevention of tetanus have long been available, serosurveys done since •977 demonstrate that 49% to 66% of the elderly population lacks a protective antitoxin level (more than 0.01 IU/mL). This study was undertaken to assess the tetanus immunization status of patients presenting to an emergency department and to evaluate their immunologic response to a tetanus booster.
Setting: The study was conducted in a tertiary care ED.
Type of participants: The patients enrolled were 65 or more years old and had breaks in their skin barriers.
Design: At each patient's initial presentation, pertinent demographic data and tetanus immunization history were recorded. The patient was then followed for 21 days.
Interventions: Each patient's antitoxin titer was determined on a serum sample by ELISA, and, if required by the Advisory Committee on Immunization Practices criteria, a booster was administered at the first visit.
Measurements and main results: Serum antitoxin assays were repeated on days 7, 14, and 21 after the initial visit until seroconversion (titer more than 0.01 IU/mL). Forty-four patients (55%)had protective levels at initial presentation, and in 36 (45%) the levels were not protective. Age and sex were not predictive of protection. Past military service and a definite history of three or more previous immunizations were good predictors of protection. Of 34 patients who were followed serially for inadequate initial titers, only 19 (56%) seroconverted by day 14. Patients who did not seroconvert were more likely to be older (P < .05).
Conclusions: This study demonstrated that a significant number of elderly patients lacked an initial protective level of tetanus antitoxin. Of these, 44% failed to seroconvert within 14 days and carried a potential risk of developing tetanus.