A patient had a severe local reaction to an injection of tetanus toxoid. Was she not immune despite past tetanus toxoid injections? Was the booster repeated too soon or too long after her last injection? When should she have her next booster? After five years? Ten years?
—Gita Dalal, MD, Edison, N.J.
Pain, redness, swelling, fever, nausea, vomiting, and headache have all been well described following injection of tetanus toxoid, but severe local reactions are uncommon. Some data suggest these reactions occur more frequently in patients who received a booster sooner than the usual 10-year interval, and for this reason, the recommendation is to administer a booster only every 10 years. Provided there were no clinical signs of an allergic reaction in your patient, it would be reasonable to repeat the tetanus toxoid by the usual schedule recommended by the CDC, namely every 10 years.
—Cedric W. Spak, MD, MPH (107-4)