Journal of the Formosan Medical Association
Volume 108, Issue 5 , Pages 395-401, May 2009

Decline of Tetanus Antitoxin Level with Age in Taiwan

  • Chi-Jung Wu

      Affiliations

    • Graduate Institute of Clinical Medicine, National Cheng Kung University, Medical College;, Tainan
    • Department of Internal Medicine, National Cheng Kung University Hospital, Tainan
    • ,
  • Huei-Chen Ko

      Affiliations

    • Department of Internal Medicine, National Cheng Kung University Hospital, Douliou Branch, Taiwan
    • ,
  • Hsin-Chun Lee

      Affiliations

    • Graduate Institute of Clinical Medicine, National Cheng Kung University, Medical College;, Tainan
    • Department of Medicine, National Cheng Kung University, Medical College;, Tainan
    • Department of Internal Medicine, National Cheng Kung University Hospital, Tainan
    • ,
  • Wei-Chuan Tsai

      Affiliations

    • Department of Medicine, National Cheng Kung University, Medical College;, Tainan
    • Department of Internal Medicine, National Cheng Kung University Hospital, Tainan
    • ,
  • Min-Gi Li

      Affiliations

    • Department of Pathology, National Cheng Kung University Hospital, Douliou Branch, Taiwan
    • ,
  • Yu-Zhen Pao

      Affiliations

    • Department of Pathology, National Cheng Kung University Hospital, Douliou Branch, Taiwan
    • ,
  • Nan-Yao Lee

      Affiliations

    • Department of Internal Medicine, National Cheng Kung University Hospital, Tainan
    • ,
  • Chia-Ming Chang

      Affiliations

    • Department of Internal Medicine, National Cheng Kung University Hospital, Tainan
    • ,
  • Hsin-I Shih

      Affiliations

    • Department of Internal Medicine, National Cheng Kung University Hospital, Tainan
    • ,
  • Wen-Chien Ko

      Affiliations

    • Department of Medicine, National Cheng Kung University, Medical College;, Tainan
    • Department of Internal Medicine, National Cheng Kung University Hospital, Tainan
    • Corresponding Author InformationCorrespondence to: Dr Wen-Chien Ko, Department of Internal Medicine, National Cheng Kung University Hospital, 138 Sheng Li Road, Tainan 704, Taiwan

Received 20 July 2008; received in revised form 24 September 2008; accepted 2 November 2008.

Article Outline

Background/Purpose 

Tetanus is caused by Clostridium tetani, and is a vaccine-preventable infectious disease. The purpose of this study was to investigate the degree of protective tetanus immunity among adolescents and adults in Taiwan, which may provide valuable information for recommendations for tetanus vaccination strategy.

Methods

Individuals aged 16 years or older who were visiting a local hospital for health examinations were invited to participate in the study. Participants' serum levels of tetanus antitoxin were measured. A standard questionnaire was used to collect demographic data and information about risk factors. The prevalence of protective tetanus immunity in various age groups was described and sociodemographic factors that potentially influenced the degree of tetanus immunity were analyzed.

Results

Overall, 326 persons were included. Of these, 217 (67%) had never received a toxoid booster, while 109 (33%) had received a booster at least once. Among all participants, 95% had protective tetanus antitoxin levels (≥ 0.11 IU/mL), and 60% had protective antitoxin levels without the need of an immediate booster, i.e. ≥ 0.51 IU/mL. Among 70 participants aged > 60 years, 89% had protective antitoxin levels ≥ 0.11 IU/mL, and 31% had protective antitoxin levels ≥ 0.51 IU/mL. Tetanus antitoxin levels declined with age. Male gender, birth after 1955, and prior receipt of toxoid booster(s) were independently associated with protective tetanus immunity (≥ 0.51 IU/mL) by multivariate analysis. Compared with those without tetanus toxoid boosters, individuals with a prior booster had higher antitoxin levels. The percentage of people with protective immunity declined if the interval between the last toxoid booster increased.

Conclusion

Waning immunity to tetanus was observed after primary tetanus vaccination or toxoid booster. The public health policy that one dose of toxoid booster after primary vaccination should be emphasized for continuing protection against tetanus.

Key Words:  seroprevalence , Taiwan , tetanus , tetanus antitoxin , vaccine

No full text is available. To read the body of this article, please view the PDF online.

 

Back to Article Outline

References 

  1. Kjeldsen K , Simonsen O , Heron I . Immunity against diphtheria and tetanus in the age group 30–70 years . Scand J Infect Dis . 1988;20:177–185
  2. Maple PA , Jones CS , Wall EC , et al.   Immunity to diphtheria and tetanus in England and Wales . Vaccine . 2000;19:167–173
  3. Christenson B , Bottiger M . Epidemiology and immunity to tetanus in Sweden . Scand J Infect Dis . 1987;19:429–435
  4. Gergen PJ , McQuillan GM , Kiely M , et al.   A population-based serologic survey of immunity to tetanus in the United States . N Engl J Med . 1995;332:761–766
  5. Karabay O , Ozkardes F , Tamer A , et al.   Tetanus immunity in nursing home residents of Bolu, Turkey . BMC Public Health . 2005;5:5
  6. Gidding HF , Backhouse JL , Burgess MA , et al.   Immunity to diphtheria and tetanus in Australia: a national serosurvey . Med J Aust . 2005;183:301–304
  7. Lee HC , Ko WC , Chuang YC . Tetanus of the elderly . J Microbiol Immunol Infect . 2000;33:191–196
  8. Chen FC , Sheen-Chen SM , Chou FF . High incidence of tetanus in the middle-aged and elderly . Changgeng Yi Xue Za Zhi . 1990;13:296–303
  9. Centers for Diseases Control, Taiwan, R.O.C. National Notifiable Disease Surveillance System, 2000–2005. [In Chinese] Available at http://www.cdc.gov.tw/en/index.asp [Date accessed: March 19, 2007]
  10. Centers for Diseases Control, United States  . Recommended Adult Immunization Schedule–United States, October 2007–September 2008 . MMWR Morb Mortal Wkly Rep . 2007;56:Q1–Q4
  11. Lee HF , Chen HM , Hsu ST . Serological survey of immune response to tetanus toxoid using antitoxin enzyme immunoassay . Zhonghua Min Guo Wei Sheng Wu Ji Mian Yi Xue Za Zhi . 1987;20:269–278
  12. Schroder JP , Kuhlmann WD . Preventive tetanus immunization and avoidance of side effects of booster immunization . Dtsch Med Wochenschr . 1992;117:1903–1906
  13. World Health Organization  . Global Programme for Vaccine and Immunization; Expanded Programme on Immunization: Module 3–Tetanus . Geneva: WHO; 1993;
  14. Huang LM , Lee CY , Hsu CY , et al.   Immunogenicity of primary DPT vaccination . J Formos Med Assoc . 1991;90:670–674
  15. Alagappan K , Rennie W , Kwiatkowski T , et al.   Seroprevalence of tetanus antibodies among adults older than 65 years . Ann Emerg Med . 1996;28:18–21
  16. Ozturk A , Goahmetoglu S , Erdem F , et al.   Tetanus antitoxin levels among adults over 40 years of age in central Anatolia, Turkey . Clin Microbiol Infect . 2003;9:33–38
  17. Matzkin H , Regev S . Naturally acquired immunity to tetanus toxin in an isolated community . Infect Immun . 1985;48:267–268
  18. Dastur FD , Awatramani VP , Dixit SK , et al.   Response to single dose of tetanus vaccine in subjects with naturally acquired tetanus antitoxin . Lancet . 1981;2:219–222

PII: S0929-6646(09)60083-8

doi:10.1016/S0929-6646(09)60083-8

Journal of the Formosan Medical Association
Volume 108, Issue 5 , Pages 395-401, May 2009

Article Tools