title: Tetanus antibody protection among HIV-infected US-born patients and immigrants.
abstract: BACKGROUND
  Public health initiatives to immunize children and adults have effectively reduced the number of tetanus cases in the USA. However, in the Third National Health and Nutrition Examination Survey (NHANES III), immigrants from Mexico had a 67% nonprotective anti-tetanus antibody (ATA) level. Less work has been conducted among other vulnerable populations such as human immunodeficiency virus (HIV)-infected patients. The objective of this study was to measure ATA levels among the HIV immigrant population compared with US-born HIV-infected patients.
  
  
  METHODS
  A convenience sample of 158 HIV-infected individuals was recruited to determine the levels of ATA. A nonprotective level of ATA was defined as below 0.15 IU/ml.
  
  
  RESULTS
  Among the HIV-infected patients, 72% (114/158) were born in the USA. A total of 17% (27/158) lacked protective levels of ATA. A total of 6.1% (7/114) of those born in the USA lacked protection, compared to 45% (20/44) born outside the USA (p < 0.0001).
  
  
  CONCLUSIONS
  The results illustrate that the country of birth is an important predictor of ATA protection, even among HIV-infected patients.
authors.affiliation: Department of Emergency Medicine, Long Island Jewish Medical Center, New Hyde Park, NY, USA. kalagapp@lij.edu
authors.forename: K
authors.initials: K
authors.lastname: Alagappan
authors.forename: J
authors.initials: J
authors.lastname: McGowan
authors.forename: D
authors.initials: D
authors.lastname: DeClaro
authors.forename: D
authors.initials: D
authors.lastname: Ng
authors.forename: R A
authors.initials: RA
authors.lastname: Silverman