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Volume 332:761-767 March 23, 1995 Number 12 Next

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ABSTRACT

Background Vaccination rates are frequently considered a surrogate measure of protection. To provide more accurate estimates, serum levels of antibody against tetanus were measured as part of the third National Health and Nutrition Examination Survey (NHANES III), which studied a representative sample of the civilian, noninstitutionalized population of the United States.

Methods We measured tetanus antitoxin using a solid-phase enzyme immunoassay in serum samples from 10,618 persons six years of age and older who were examined during phase 1 of NHANES III in 1988 to 1991.

Results Overall, 69.7 percent of Americans six years of age and older had protective levels of tetanus antibodies (>0.15 IU per milliliter). The rate decreased from 87.7 percent among those 6 to 11 years of age to 27.8 percent among those 70 years of age or older. Among children 6 to 16 years of age, 82.2 percent had protective levels of tetanus antibodies, with little variation according to race or ethnicity. More men than women were immune (79.0 percent vs. 62.4 percent). Mexican Americans had a significantly lower rate of immunity (57.9 percent, P<0.05) than either non-Hispanic whites (72.7 percent) or non-Hispanic blacks (68.1 percent). Those with a history of military service, higher levels of education, or incomes above the poverty level were more likely to have protective antibody levels. Although the prevalence of immunity declined rapidly starting at the age of 40 years, most of the 107 cases of tetanus (with 20 deaths) reported in 1989 and 1990 occurred in persons 60 years of age or older.

Conclusions Despite the fact that effective vaccines against tetanus have been available since the 1940s, many Americans do not have immunity to tetanus, and the rates are lowest among the elderly. There is an excellent correlation between vaccination rates (96 percent) and immunity (96 percent) among six-year-olds. However, antibody levels decline over time, and one fifth of older children (10 to 16 years of age) do not have protective antibody levels.

Source Information

From the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md. (P.J.G.); National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Md. (G.M.M., T.M.E.-R.); Maternal and Child Health Bureau, Health Resources Service Administration, Rockville, Md. (M.K.); National Immunization Program, Centers for Disease Control and Prevention, Atlanta (R.W.S.); and Department of Microbiology and Immunology, Medical University of South Carolina, Charleston (G.V.).

Address reprint requests to Dr. Gergen at Solar, Rm. 4A29, 6003 Executive Blvd., MSC 7640, Bethesda, MD 20892-7640.

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Protection against Tetanus
Gardner P., LaForce F. M., Sutter R. W., Hadler S. C., McQuillan G., Gergen P. J.
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