Tetanus and diphtheria still health threats

July 1, 1993

Tetanus and diphtheria still health threats

By ARA Content

When was the last time you heard about the dangers of tetanus or diphtheria? Did you know that virtually all U.S. children are vaccinated against these diseases before entering school, yet more than half of adults age 20 years and older in the United States do not have protective levels of antibodies for both diseases? The good news is that protecting yourself against tetanus or diphtheria infection is simply a matter of remembering to periodically boost your immunization.

The main reason so many adults are unprotected is that the childhood vaccines for tetanus and diphtheria do not provide lifelong protection. To prevent tetanus and diphtheria, the U.S. Centers for Disease Control and Prevention (CDC) recommends that all adults who completed their primary vaccination series as children get a booster shot every 10 years throughout life.

“While tetanus and diphtheria are both uncommon today in the United States, people still need to get their adult boosters,” says Dr. William Schaffner, M.D., professor and chairman, department of preventive medicine at Vanderbilt University and a national expert in infectious diseases. “Many older persons may never have been adequately vaccinated, especially those over 65 years old who were beyond school age in the 1940s. These people are particularly at-risk and may actually need to get the primary vaccination series. After initial immunization, all adults need a tetanus-diphtheria booster shot every 10 years.”

The most common form of tetanus causes paralysis, usually starting at the top of the body and working its way down. Lockjaw is often the first sign, followed by stiffness in the neck and difficulty swallowing. Symptoms can appear anywhere from three days to three weeks after exposure to tetanus bacteria, which is widespread in soil and can enter the body through any wound.

Three recent cases of tetanus infection in Puerto Rico involved people aged 68 to 86 years old. One person suffered a puncture wound from stepping on a rusty nail; the other two were infected from splinter wounds. While most people may recognize that a puncture wound requires a tetanus booster shot, many wouldn’t think to get vaccinated because of a splinter. Because a physician may not always treat minor wounds that could cause tetanus, the only way to prevent infection is to maintain up-to-date Td booster immunizations.

None of the three people in Puerto Rico received regular booster doses, nor did any of them appear to have prior vaccination against tetanus. Two died from their infections; the 76-year-old patient survived, but spent nearly eight weeks recovering in a hospital.

Preventing infections with routine booster shots is the preferred use of the tetanus vaccine, but it can also prevent an infection if given when a wound is being cleaned—assuming the individual has previously received the three-shot primary series. The tetanus booster generally comes in combination with a diphtheria booster—called a Td shot; one shot provides protection against both diseases for 10 years.

The germ that causes diphtheria is spread from person to person, entering the body through the nose and throat. Symptoms, such as fatigue, sore throat, loss of appetite, and low-grade fever usually begin about two to five days after exposure. Eventually, diphtheria can cause life-threatening conditions such as inflammation in the heart and respiratory failure.

Due to widespread vaccination, diphtheria is now very rare in the United States, although it continues to exist in other parts of the world. Beginning in 1990, a major diphtheria epidemic occurred in countries of the former Soviet Union. By 1994, there were more than 157,000 cases and more than 5,000 deaths reported. This outbreak is a reminder that even a well-controlled infection can re-emerge when population immunity is not maintained.

In addition to recent cases of tetanus in this country and the pockets of diphtheria around the world, the case for preventive vaccination (especially in older adults) is further supported by the study mentioned earlier—approximately half of all Americans older than age 60 do not have protective levels of antibodies for tetanus, and close to two-thirds do not have protective levels of antibodies for diphtheria. For people older than age 70, the situation gets worse; 70 percent of this group lack protective levels of antibodies for tetanus and diphtheria.

Additionally, a recent study found that, despite the virtual elimination of diphtheria in the United States, dangerous strains of the bacteria continue to circulate in some communities within the U.S. and Canada. These findings, coupled with low levels of protection against diphtheria in adults, could set the stage for a diphtheria comeback in the two countries. The best way to prevent diphtheria from circulating in the United States is to increase each person’s level of protection with up-to-date immunizations; this will provide the public with enough “herd immunity” to stop the spread of infection.

Dr. Schaffner advises that, “Everyone who has not had their complete series of tetanus and diphtheria vaccinations, or cannot remember getting a Td booster within the last 10 years should call their doctor today to get immunized.” Information: www.cdc.gov.

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