http://www.avn.org.au/tetanus.htm

 

Current Case Definition for Surveillance

The clinical case definition of tetanus is: "Acute onset of hypertonia and/or painful muscular contractions (usually of the muscles of the jaw and neck) and generalized muscles spasms without other apparent medical cause." Cases meeting the clinical case definition are considered confirmed.

Source: http://edcp.org/html/tetanus.html

Recurrent Abscess Formation Following DTP Immunizations: Association with Hypersensitivity to Tetanus Toxoids; Pediatrics, 1985

Adverse local reactions to vaccines containing diphtheria and tetanus toxoids and pertussis antigen (DTP) are common but generally benign. Most often, these reactions are manifested by erythema, induration and tenderness occurring at the injection site 12 to 24 hours following immunization. Less frequently, abscess formation may complicate intramuscular injections and these may be staphylococcal, clostridial, or sterile in etiology.

Tetanus toxoid has been associated with a reaction incidence of 3% to 13%, and adverse reactions appear to be related to the number of prior immunizations and the height of preexisting antibody responses. However, recurrent abscess formation associated with hypersensitivity to one or more of the components of the DTP vaccine has not been reported previously.

The purpose of this paper is to describe a child with recurrent local abscess formation following DTP immunizations. Results of delayed-type hypersensitivity (DTH) skin tests suggested that hypersensitivity to tetanus toxoid was causally related to her adverse local reactions. A testing procedure is suggested for patients with recurrent, severe, or progressive local reactions to DTP immunizations.

Edsall, G; Elliott, MW; Peebles, TC; Levine, L; Eldred, MC; Excessive Use of Tetanus Toxoid Boosters; JAMA; Oct. 2, 1967; Vol 202, No. 1

Abstract: The prevailing tetanus antibody levels on 45 children seen for routine or emergency booster injections of tetanus toxoid were all 40 to 2,500 times above the minimum protective level. Antibody levels in 22 other patients with allergic or Arthus-type reactions to tetanus toxoid were, without exception, above the threshold of protection, and all but one were many times higher. Booster doses of tetanus toxoid are being given with unnecessary and indeed excessive frequency; continuing to do this will produce a more highly toxoid-sensitive population without adding significantly to the already high protection that this immunized population has against tetanus. It is recommended that annual routine toxoid boosters of all kinds be discontinued, that routine boosters in individuals known to have had primary immunization including a reinforcing dose be given only at ten-year intervals and that emergency boosters be given no closer than one year apart.

Pollard, JD; Selby, G; Relapsing Neuropathy due to tetanus toxoid; Journal of the Neurological Sciences, 1978, 37: 113-125

Summary: A unique case history is presented of a 42-year-old patient who has suffered three episodes of a demyelinating neuropathy, each of which followed an injection of tetanus toxoid. The clinical features on each occasion were characteristic of acute idiopathic polyneuropathy; a rapid onset of a mainly motor neuropathy with eventual recovery. Nerve conduction studies performed during the second and third episodes demonstrated grossly slowed motor conduction velocities. The sural nerve was biopsied after the third episode, and the features seen on light and electron microscopy included prominent hypertrophic changes, mononuclear cells associated with most :onion bulbs" and macrophage mediated demyelination. Studies of blastogenesis and macrophage migration inhibition, showed T lymphocyte responsiveness to both peripheral nerve myelin and tetanus toxoid. Typing for antigens of the HLA system indicated that the patient was homozygous for HLA.

Crone, NE; Reder, AT; Severe tetanus in immunized patients with high anti-tetanus titers; Neurology 1992; 42:761-764;

Article abstract: Severe (grade III) tetanus occurred in three immunized patients who had high serum levels of anti-tetanus antibody. The disease was fatal in one patient. One patient had been hyperimmunized to produce commercial tetanus immune globulin. Two patients had received immunizations one year before presentation. Anti-tetanus antibody titers on admission were 25 IU/ml to 0.15 IU/ml by hemagglutination and ELISA assays; greater than 0.01 IU/ml is considered protective. Even though one patient had seemingly adequate anti-tetanus titers by in vitro measurement 0.20 IU in vivo mouse protection bioassays showed a titer less than 0.01 IU/ml, implying that there may have been a hole in her immune repertoire to tetanus neurotoxin but not to toxoid. This is the first report of grade III tetanus with protective levels of antibody in the United States. The diagnosis of tetanus, nevertheless, should not be discarded solely on the basis of seemingly protective anti-tetanus titers.   

 

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