Abstract
To assess the characteristics of tetanus in previously immunized individuals. A systematic literature search was undertaken using Ovid MEDLINE(R) and EMBASE databases for articles published between 1946 and September 3, 2013. The search strategy was developed using MESH terms for "tetanus", "immunization" and "vaccination". Inclusion criteria were articles in English or French that described at least one case of tetanus, immunization history and/or the results of anti-tetanus antibodies. Articles were reviewed for relevant references. 51 unique articles published from1946-2013 were included in the review. The articles described 359 cases of clinical tetanus in individuals with prior receipt of one or more doses of tetanus toxoid vaccine and/or levels of tetanus antibody titres generally considered protective. Of the 210 cases that reported patient status at discharge, 180 (85.7%) survived with only three cases reporting residual deficits. Tetanus spores are ubiquitous and this report clearly documents that tetanus cases can occur in individuals previously immunized with tetanus toxoid vaccine. Clinicians should not rule out tetanus when clinical symptoms suggest it, regardless of the vaccination history. When treated, the prognosis for tetanus is good. Further research is needed to assess the incidence of tetanus in partially- and fully-immunized populations and determine whether this is due to waning immunity of vaccine failure.
Highlights
A previously healthy 22 year-old man presented to an emergency department in Ontario, Canada with symptoms of spasm and trismus consistent with tetanus
Fourteen cases had tetanus antibody titres drawn prior to administration of antitoxin, while the remaining 345 cases had immunization confirmed on record review
As more than half of the cases did not report the number of doses of tetanus toxoid received and there were a small number of deaths (n=30), it was not possible to analyze survival data by number of doses
Summary
Twenty-seven days prior to presentation, he reported a minor injury to the left great toe that appeared to form an abscess. He lanced the abscess himself, but the wound worsened whereupon he sought medical treatment. No additional tetanus-containing vaccine was given when he initially sought medical treatment. The patient was treated with tetanus immune globulin, antibiotics and supportive care. During his course in hospital, the patient improved and was discharged 20 days after admission, with a full recovery reported 12 weeks following initial presentation
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