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Abstract
Tetanus is a vaccine-preventable disease that is otherwise life-threatening. Tetanus is caused by Clostridium tetani bacteria found in soil and manure. In unvaccinated persons, tetanus can be fatal, but severity is abated in fully vaccinated persons. In the United States (US), the Advisory Committee on Immunization Practices (ACIP) recommends a three-dose childhood immunization primary series with a tetanus toxoid-containing vaccine for children at 2, 4, and 6 months old to be followed by two booster doses administered between the ages of 15-18 months and 4 to 6 years. ACIP further recommends that adults receive decennial tetanus booster vaccinations at ages 11-12 years. Serologic data on vaccine-preventable diseases are used to assess the success of immunization programs, the duration of vaccine-induced immunity, and to identify susceptible subpopulations. Recent epidemiological trends in tetanus disease incidence along with results from previous serosurvey, new laboratory findings, and modelling studies suggest a high prevalence of tetanus seroimmunity in examined populations. These findings impel examination current adult tetanus booster vaccination recommendations.
This observational cross-sectional study analyzed tetanus serum antibody levels collected from 5,910 participants of the National Health and Nutrition Examination Survey (NHANES), 2015-2016 using a microsphere-based multiplex antibody assay (MMACA). The objective was to provide national estimates of tetanus immunity among persons aged six years or older.
Results: Approximately 94% of the US population was seroprotected against tetanus as defined by a protective serum antibody level of ≥0.10 international units per milliliter (IU/mL). However, proportions of seroimmunity declined with advancing age after 60 years. Prevalence of seroimmunity was lower among females than males, and the gap increased with advancing age. Older adults, Hispanic persons, non-Hispanic black persons, divorced, widowed, or separated persons, foreign-born Americans, and those with less than high school education were more likely to be susceptible to tetanus. The population of older adults aged ≥65 years is forecasted to nearly double by 2050. This poses a significant public health challenge as older have a higher burden of tetanus disease from illness, hospitalization, disability, and death. Additional studies are needed to evaluate US adult tetanus booster vaccination recommendations.