Abstract
In Reply. —A single tetanus booster for adults at the age of 65 years, as proposed by Drs Balestra and Littenberg,1may appear to be an appropriate tetanus prevention policy on the basis of cost-effectiveness analysis. For several reasons, however, we do not recommend changing the vaccination policy of decennial booster doses of tetanus and diphtheria toxoid (Td) at this time. First, neither person who developed tetanus in Kansas in 1993 had a history of receiving any tetanus vaccination.2Furthermore, serologic surveys have indicated that 31% to 71% of older adults (who may have never received the primary three-dose Td series) lack protective levels of antibody against tetanus.3Although compliance with the decennial Td vaccination policy recommended by the Advisory Committee on Immunization Practices (ACIP)4may be suboptimal, these doses may provide catch-up immunizations to people who never received the primary series. Second, many persons, such
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