Tetanus immunization status and predictors of immunity in older family practice outpatients.

Effective immunization programs initiated many years ago have made tetanus a rare disease in the United States today. These programs have been so successful that in 1981 the Sixth International Conference on Tetanus (Lyon, France) proposed a goal of eliminating tetanus from the United States by 1985 and from the rest of the world by the year 2000.1 This goal has yet to be achieved. During the last two decades 50 to 100 cases have been reported each year.2 Between 1991 and 1994 there were 201 reported cases of tetanus in the United States, 54 percent in persons who were older than 60 years.3 Ninety-five percent of patients with tetanus reported to the Centers for Disease Control and Prevention had not completed a primary immunization series.4 The low tetanus mortality rate (deaths per population at risk) in the United States is due to preventive rather than therapeutic efforts. The case fatality rate (deaths per cases of disease) remains high at 25 percent.3 Immunization, therefore, remains the most important element in reducing the mortality rate of the disease. The US immunization strategy, stated in Healthy People 2000, targets the young,S although a tetanus booster is recommended for all adults every 10 years. Tetanus immunity declines with age, however,6,7 and currently the highest rates of tetanus infection and associated mortality occur in patients older than 65 years.6-9 A few studies have attempted to determine the relation between historical data and tetanus antibody