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Tetanus

"Classen's data and other published data indicates the following vaccines are associated with an increased risk of diabetes (increased risk): hepatitis B (50%), hemophilus (25%), tetanus (20%), diphtheria (9%), pertussis (25%), mumps- rubella (23%).  These findings are supported by a case control study performed in Europe.  The cumulative effect of all these vaccines on diabetes is tremendous."--PRNewswire

"Wounds that bleed will never result in tetanus because the tetanus bacillus is anaerobic. It is absolutely silly to vaccinate boys who cut their knees. The only reason behind that is money."--Dr Buchwald MD

"If your immunisation income is below the national average, offer tetanus boosters for adults who have not received one in the preceding 10 years. Also pick up those who have never had a primary course. You could do this opportunistically during consultations or by recall from the computer. Check on immunisation status at new patient checks.  With tetanus (as well as typhoid and infectious hepatitis), you can generate income from reimbursement for personally administered vaccine under paragraph 44.5 of the Red Book. "---Financial Pulse

" In Philadelphia and vicinity there were in the autumn of 1901 no fewer than thirty-six cases of tetanus, or lockjaw, which were admitted to have resulted from vaccination, and nearly all were fatal."--John Pitcairn

"Now it happened that wood was particularly scarce (in) the country, so the cases of the anti-tetanic serum were a God-send as kindling, as we were badly in want of tea.  As regards the anti-tetanic serum we chucked the bottles full of it over the trenches also; it went over the top after the dead Turks."--Lt Col Donegan (1925)

Tetanus from (smallpox) vaccine

American Life League: A Tetanus Vaccine That Kills...

[Media Spring 1994 Tetanus vaccine--arthritis] Letter to Mothering Magazine

Dangers in Tetanus vaccine

P only dangerous in DPT? (autism)

BMJ 2000;320:383 ( 5 February )

Letters
Immunisation does not rule out tetanus

EDITOR
Shimoni et al illustrate a needed caution to clinicians:
do not exclude a diagnosis of tetanus in a patient who has been
fully immunised.1 Their report adds to the list of rare cases of
tetanus that have occurred despite complete immunisation. Although the
authors state that all reported cases of tetanus in the United
States have occurred in people who have not been immunised, this is
not altogether true. A catalogue of the 740 tetanus cases reported by
the Centers for Disease Control since 1982 discloses that of the
minority whose immunisation status was known, 53 cases had completed a
primary series, 22 had received their latest booster between five and
nine years before, and two had received a booster within five years

(table)
>           Immunisation status of patients with tetanus
>  in the United States reported by the Centers for Disease Control
_____________________________________________________________________
                      Immunisation    Primary series    Latest booster
Years - No of cases - status known -  completed -  5-9 years, <5years

_______________________________________________________________________

1995-97    122              56             16             6           2
1989-90    117              57             12             4           0
1987-88    101              46             5              2           0
1985-86    147              NR             9              5           0
1982-84    253              NR            11              5           0

  NR = not reported.  
_______________________________________________________________________

   
                  
In light of their patient's adequate immunisation record, Shimoni et
al presume that he should have mounted a protective titre of
neutralising antibody. With this I agree. But against what, in
particular, does this titre confer protectionclinical infection or
fatal infection? The understanding of "protection" was derived from
animal studies that correlated serum concentrations of tetanus
antibody with symptoms of tetanus.2 The threshold of 0.01 IU/ml was
established because guinea pigs with titres above this level were
protected from fatal tetanus, not from clinical tetanus; six of 45
animals with protective levels developed non-fatal tetanus.3
Similarly, in humans, non-fatal tetanus has been described in 10 out
of 64 consecutive patients with antitetanus titres greater than 0.01
IU/ml.4 More recent cases have borne this out.5

A number of rare and exceptional cases of tetanus occur despite
adequate immunisation and protective levels of neutralising
antibodies. Since tetanus is likely to be fatal if not recognised and
treated properly, the caveat from Shimoni et al1 merits repeating:
doctors should entertain the diagnosis of tetanus in the proper
clinical setting, regardless of the patient's immunisation record.

David R Vinson, staff physician. 
Department of Emergency Medicine, Kaiser Permanente Medical Center,
Sacramento, CA 95825, USA
drvins@netscape.net


 1. Shimoni Z, Dobrousin A, Cohen J, Pitlik S. Tetanus in an immunised
patient. BMJ 1999; 319:1049[Full Text]. (16 October.)
 2. McComb JA. The prophylactic dose of homologous tetanus antitoxin.
N Engl J Med 1964;270: 175-178.
 3. Sneath PAT, Kerslake EG, Scruby F. Tetanus immunity: the
resistance of guinea pigs to lethal spore doses induced by active and
passive immunization. Am J Hygiene 1937; 25: 464-476.
 4. Goulon M, Girard O, Grosbuis S, Desormeau JP, Capponi MF. Les
anticorps antitétaniques: titrage avant séro-anatoxinothérapie chez 64
tétaniques. Nouv Presse Med 1972; 1:3049-3050[Medline].
 5.  Crone NE, Reder AT. Severe tetanus in immunized patients with
high anti-tetanus titers. Neurology 1992; 42: 761-764[Medline].

© British Medical Journal 2000

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