Recently, I experienced a severe local reaction to tetanus (Item 107-4), and subsequent immunization resulted in a systemic reaction that included swelling, pain, fever, and malaise for three days. Further testing revealed allergy to both tetanus toxoid and antitoxin as well as immunity to the toxin. Two of my patients who had similar reactions were also immune by titer. I now recommend checking titers and forgoing further immunizations if the titer levels are found to be adequate.

On another point, the recommendation for a tetanus booster every 10 years is based not on outcomes studies but on an early 1900s study that showed adequate titers at 20 years. The time interval between immunizations was cut in half to be safe. The recommendation for cutting the 10-year immunization in half again to five years post injury was also based on “being safe,” not on clinical evidence.
—Victor Aaen, MD, DrPH, Angwin, Calif. (109-25)

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