title: Decline of tetanus antitoxin level with age in taiwan.
abstract: OBJECTIVE
  Tetanus is caused by Clostridium tetani, and is a vaccine-preventable infectious disease. The purpose of this study was to investigate the degree of protective tetanus immunity among adolescents and adults in Taiwan, which may provide valuable information for recommendations for tetanus vaccination strategy.
  
  
  METHODS
  Individuals aged 16 years or older who were visiting a local hospital for health examinations were invited to participate in the study. Participants' serum levels of tetanus antitoxin were measured. A standard questionnaire was used to collect demographic data and information about risk factors. The prevalence of protective tetanus immunity in various age groups was described and sociodemographic factors that potentially influenced the degree of tetanus immunity were analyzed.
  
  
  RESULTS
  Overall, 326 persons were included. Of these, 217 (67%) had never received a toxoid booster, while 109 (33%) had received a booster at least once. Among all participants, 95% had protective tetanus antitoxin levels (> or = 0.11 IU/mL), and 60% had protective antitoxin levels without the need of an immediate booster, i.e. > or = 0.51 IU/mL. Among 70 participants aged > 60 years, 89% had protective antitoxin levels > or = 0.11 IU/mL, and 31% had protective antitoxin levels > or = 0.51 IU/mL. Tetanus antitoxin levels declined with age. Male gender, birth after 1955, and prior receipt of toxoid booster(s) were independently associated with protective tetanus immunity (> or = 0.51 IU/mL) by multivariate analysis. Compared with those without tetanus toxoid boosters, individuals with a prior booster had higher antitoxin levels. The percentage of people with protective immunity declined if the interval between the last toxoid booster increased.
  
  
  CONCLUSIONS
  Waning immunity to tetanus was observed after primary tetanus vaccination or toxoid booster. The public health policy that one dose of toxoid booster after primary vaccination should be emphasized for continuing protection against tetanus.
authors.affiliation: Graduate Institute of Clinical Medicine, National Cheng Kung University, Medical College, and Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
authors.forename: Chi-Jung
authors.initials: CJ
authors.lastname: Wu
authors.forename: Huei-Chen
authors.initials: HC
authors.lastname: Ko
authors.forename: Hsin-Chun
authors.initials: HC
authors.lastname: Lee
authors.forename: Wei-Chuan
authors.initials: WC
authors.lastname: Tsai
authors.forename: Min-Gi
authors.initials: MG
authors.lastname: Li
authors.forename: Yu-Zhen
authors.initials: YZ
authors.lastname: Pao
authors.forename: Nan-Yao
authors.initials: NY
authors.lastname: Lee
authors.forename: Chia-Ming
authors.initials: CM
authors.lastname: Chang
authors.forename: Hsin-I
authors.initials: HI
authors.lastname: Shih
authors.forename: Wen-Chien
authors.initials: WC
authors.lastname: Ko
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D006801:Humans; D007117:Immunization, Secondary; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012727:Sex Characteristics; D013624:Taiwan; D013743:Tetanus Antitoxin / Q000097:blood*; D013745:Tetanus Toxoid / Q000276:immunology
chemical_list: D013743:Tetanus Antitoxin; D013745:Tetanus Toxoid