I was surprised at the diagnosis of tetanus in a person whose last booster was two years earlier (“Severe muscle spasms and jaw stiffness after stepping on a nail,” April 2010). Was this information in error? If not, what is the explanation for the failure of the immunization?—JoAnn Ferris, CFNP, Lafayette, Ind.

The patient was adamant that she had received a tetanus booster two years earlier, but we were never able to obtain documentation to verify this. If she did receive the booster, she may have been a nonresponder. While I am not aware of tetanus nonresponders in the literature, there are occurrences with hepatitis and varicella vaccines.—Patricia W. Poole, APRN-BC, ACNPC, CCRN (140-14)

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