Tetanus immunisation in the elderly population.

OBJECTIVE To emphasise that tetanus still occurs in the United Kingdom, particularly in elderly people-as illustrated by two case reports-and to examine the state of tetanus immunity in elderly people. METHODS 111 elderly people (over 65 years) were studied: 43 males, mean age 77.7 years, range 67-94; 68 females, mean age 81.3 years, range 67-95. They were either attending the accident service or were hospital inpatients. An attempt was made to obtain an immunisation history and antitetanus antibody titres were measured. RESULTS Immunisation history was uncertain and unreliable. Measurement of antibody titres showed that they were inadequate to ensure protection in 50% of those studied. Low levels were particularly prevalent in the over 80 age group and in females. Questioning about military service confirmed that this had predominantly involved males. CONCLUSIONS Elderly people are at risk of contracting tetanus and should be targeted for community immunisation. Extra precautions in the form of passive immunisation with human anti-tetanus immunoglobulin should be used in this age group in addition to the usual wound management measures when the elderly sustain tetanus prone injuries.