believing it was better
to "over protect" than to risk the development of a "fatal" case of tetanus.
Discovering that most
people recover from an acute bout of tetanus was unexpected, but it was
disconcerting to find that many of the reported cases of tetanus were in
"fully vaccinated" people. A review of the Morbidity and Mortality Weekly
Report (MMWR) from the CDC called "Tetanus Surveillance -- United States,
1995 -- 1997] revealed unexpected information and facts. However, because
this report is bogged down with complicated statistics that must be
methodically disentangled, it is no wonder that few are aware of its
The document discusses
124 cases of tetanus reported between 1995 and 1997. Here is what was
Nearly twenty -- five percent (24.8%) of
those who contracted acute tetanus had at least one dose of the vaccine and
more than twelve percent (12.4%) of the patients were fully vaccinated, with
three or more doses of tetanus. Of the 66 (53.7%) people who had an "unknown
vaccination status," it could reasonably be assumed that a portion of those
had had one or more tetanus shots at some point in their lives. Therefore,
statement made by the CDC that "the disease continues to occur almost
exclusively among persons who are unvaccinated, inadequately vaccinated or
whose vaccination histories are unknown or uncertain" is simply not true.
The "rationale" for getting a tetanus shot is that milder cases will result
among the vaccinated. This is an argument used with all the mandated the
vaccines Yet, given that the fatality rate (11.2%) is lower than reported
and the apparently low incidence overall, the following questions should be
1) What is the real risk of getting a
severe case of tetanus if you are unvaccinated?
2) How many cases of serious tetanus would
occur were all wounds cared for properly?
3) What antibody level actually confers
protection from a serious case of tetanus?
The truth is, the antibody level required
to be universally protective is unknown. The "generally accepted" protective
level for tetanus antibody > 0.15 IU/mL. This level was proposed by Snead
in1937, and has been the accepted "standard" since that time. However, the
number is arbitrary and not guaranteed to protect from infection.
Therefore, routinely vaccinating every 10 years, as the journal article
suggests, simply to maintain "adequate antibody levels" is uncalled for and
may not only provide the person with a false sense of security, it may
actually cause harm. Tetanus vaccines haven't gotten the "bad press" many
of the other vaccines have recently received. In the zeal to protect from
this "deadly disease," it is imagined that the risk of infection far exceeds
the potential risk of the vaccine. What harm could it do? I thought the
vaccine only contained inactivated tetanus toxin and sterile water. I am
convinced that is the perception of nearly all physicians. It was disturbing
to learn of the other ingredients that are in the tetanus toxoid vaccine:
formaldehyde; sodium phosphate monobasic; sodium phophate dibasic, [an eye
and skin irritant that may be harmful if ingested]; glycine, aluminum, and
25 ug. of thimerosal (mercury). There is obviously more to the tetanus
vaccine than inactivated toxoid! In the Emergency Department, if the tetanus
status of a patient is "unknown," an additional shot is routinely given,
because it is thought to be harmless. However, this is simply bad medicine.
If the person doesn't need the tetanus booster, the vaccine can cause a
severe allergic reaction referred to as an Arthus type, Type III
hypersensitivity reaction. This side effect is defined as "an acute
inflammatory reaction caused by deposition of antigen -- antibody complexes
into the tissues."
The "Arthus type" variation classically
causes a reaction only at the injection site, but the result is an acute
necrotizing vasculitis and localized necrosis (death) of the tissues. The
reaction starts 2 -- 8 hours after a tetanus toxiod injection and occurs if
the person has very high serum antitoxin antibodies due to overly frequent
injections. In addition to the local reaction, severe systemic reactions can
occur. A partial list of adverse events includes headache; nausea; vomiting;
arthralgias; tachycardia; syncope (fainting); cranial nerve paralysis; and a
variety of neurological complications including EEG disturbances, seizures
and encephalopathy; anaphylaxis and
Recommending "routine" tetanus boosters based on mathematical models of
antibody degradation can result in severe complications and is risky
But what about diphtheria? Do we need to
keep our guard up about this infection?
Diphtheria is an infection caused by the
gram -- positive bacteria, Corynebacterium diphtheriae, its name derived
from a Greek work meaning "leather hide." Early symptoms include sore
throat, malaise, and a low -- grade fever. Although cutaneous diphtheria
infections occur, the most common form of the infection occurs in the
tonsils and pharynx. If not treated early, a grayish -- green membrane
develops in the back of the throat which may lead to respiratory
obstruction. Similar to tetanus, the complications from diphtheria are
caused by a toxin released from the infecting bacteria. The severity of the
disease is related to the amount of toxin that is absorbed systemically from
the infection site. The most frequent complications caused by the toxin
include cardiac arrhythmias and nerve paralysis involving the palate, eyes,
limbs and diaphragm. Even with these extensive complications, complete
recovery usually occurs within five weeks of onset. Death occurs without
medical support for the complications. Complete recovery? Here we go again…
There are many different species of
Corynebacterium commonly found in soil, dust and contaminated water and most
do not result in serious infection. In fact, most strains of C. diphthereae
do not produce the disease -- causing toxin! Only when the bacteria has been
infected by a specific virus, called a B phage, will the toxin be produced.
The B phage contains the specific genetic information to code for the toxin,
therefore, only strains infected with the virus cause severe disease. The
important question, then, is, how often such an event occurs.
The article refers to a "recent outbreak"
of diphtheria in the former Soviet Union as the primary reason to
revaccinate. It is assumed that a decrease in vaccination rate was the most
significant cause for the 1990 -- 1995 diphtheria outbreak in the Newly
Independent States (NIS). This epidemic is often cited as the reason to
maintain high vaccination rates. Let's take a closer look at what was
happening in the Soviet Union at that time. In 1991, fifteen new countries
had just become independent with the dissolution of the USSR and shortly
thereafter, the infrastructure of the region completely collapsed. Garbage
piled up in the streets of Moscow and other cities. Large refugee and
migrant camps descended upon the major urban areas. Health care services,
including disposable syringes and needles, were virtually non -- existent.
By 1995, Russia's annual health care
budget was slightly less than 1 percent, about the same as the poorest
African nations. Half of the country's 21,000 hospitals had no hot water, a
quarter had no sewage systems, and several thousand had no water at all. In
the operating rooms, truly sterile instruments were rare and blood was being
washed off the hospital floor with a garden hose. More than 150,000 acute
infections and nearly 5,000 deaths from diphtheria were estimated to have
occurred between 1990 and 1998. However, even with the initiation of
widespread immunization campaigns by the World Health Organization in 1994,
more than 2,700 cases were still reported in 1998. Comparing what happened
in the NIS to what might happen if antibody levels fall in the US, without
taking into account the living conditions in each country, is an invalid
What about the vaccines?
There are several available vaccine
choices: tetanus toxoid (TT); adult diphtheria toxoid plus tetanus toxoid (dT);
pediatric diphtheria toxiod plus tetanus toxoid (DT) and tetanus immune
globulin (TIG). The diphtheria vaccine is not obtainable separately Like the
tetanus vaccine, the diphtheria vaccine is made from the toxin of C.
diphtheriae. The bacteria is grown in a casein medium and the final product
contains ammonium sulfate, residual formaldehyde, sodium bicarbonate, 0.3 mg
aluminum phosphate and 25ug thimerosal. The tetanus toxoid vaccine (TT) was
discussed previously and is the vaccine most commonly given. There are two
forms of diphtheria vaccine, pediatric (D) and adult (d) and this vaccine is
always given in combination with tetanus toxoid. Therefore, the pediatric
vaccine is DT and the adult vaccine is dT. The distinction is made because
the DT form contains 8 times more diphtheria toxoid than the dT form. It is
contraindicated to give the pediatric vaccine, DT, to adults or to children
over the age of 7 years because of the increased the likelihood of side
effects. Infants are given 4 doses of the DT form (as DTP or DTaP) during
the first 12 months of life. The result is that infants receive 32 times
the dose of diphtheria toxin from the DT form than they would receive if the
dT form was used. The reason the higher concentration is "safe" for smaller,
younger children is unclear. Tetanus Immune Globulin (TIG) is a vaccine
that contains tetanus toxin antibodies derived from the plasma of donors
previously vaccinated with tetanus toxoid. This vaccine is considered to
give "passive immunization," meaning that the antibodies are supplied at the
time of immediate need. Peak antibody blood levels from this vaccine are
obtained approximately 2 days after the injection and remain in circulation
for approximately 23 days. TIG can be used following an acute injury in
patients whose immunization status is unknown or incomplete.
What are the other treatment choices?
Although proper wound hygiene has been
known since the 1940's to be the best way to prevent infection, it tends to
be overlooked as the best way to prevent tetanus. Regardless of immunization
status, dirty wounds should be properly cleaned and crushed tissue should be
can be prevented by thorough hand washing and good nutrition.
Antibiotic regimens are available for the treatment of both tetanus and
diphtheria infections. The Red Book™, published by the American
Academy of Pediatrics makes a suggestion
for an alternative treatment for tetanus. The antibiotic, metronidazole (30
mg/kg/day) given at 6 -- hour intervals is effective in reducing the
bacterial count in a wound. Metronidazole is the antibiotic of choice for
dirty wounds. Another choice is injectable penicillin G (100 000 U/kg/day),
given at 4 -- to 6 -- hour intervals. These therapies should be continued
for 10 to 14 days. It appears that a prophylactic course of antibiotics
would be prudent for dirty wounds to prevent the possibility of C. tetani
germination and toxin production. Additionally, there is an antibiotic
treatment available for diphtheria infections. Erythromycin orally or by
injection (40 mg/kg/day; maximum, 2 gm/day) or procaine penicillin G daily,
intramuscularly (300,000 U/day for those weighing 10 kg or less and 600,000
U/day for those weighing more than 10 kg) can be given for 14 days. The
disease is usually not contagious 48 hours after antibiotics are instituted.
Elimination of the organism should be documented by two consecutive negative
throat cultures after therapy is completed. Indeed, since nearly every
sore throat is treated by conventional medicine with an antibiotic, perhaps
this is the reason for the decreased the incidence of diphtheria, and not
the vaccine. A third option is to use the TIG vaccine at the time of acute
injury. It appears that treatment with TIG is an adequate form of treatment.
The package insert states the following:
"If a contraindication to using tetanus
toxoid preparations exists for a person who has not completed a primary
series of tetanus toxoid immunization and that person has a wound that is
neither clean nor minor, only passive immunization should be given using
tetanus immune globulin."
With all of these options available,
routinely vaccinating adults to maintain an arbitrary antibody level should
be considered inappropriate healthcare. In addition, knowing the real facts
about these infections and being aware of the available treatment
options should be a comfort to parents who choose not to vaccine.
1948 two Harvard Medical School scientists, Randolph Byers and Frederick
Moll carried out tests on the DPT at Children’s Hospital in Boston and
concluded that severe neurological problems followed administration of the
vaccine. The results were published in Pediatrics, a respectable
medical journal. The results were completely ignored by the medical and
pharmaceutical community. In 1976, Charles Manclark, an FDA scientist,
remarked, “The DPT had one of the worst failure rates of any product
submitted to the Division of Biologics for testing.”
Also, take a look at what Dr. Mendelsohn says about Tetanus;
(The People's Doctor Newsletter 1976-1988)
You have every right to closely question me on the tetanus vaccine, since
that was the last vaccine I abandoned. It wasn't hard for me to give up
vaccines for whooping cough, measles, and rubella because of their disabling
and sometimes deadly side effects. The mumps vaccine, a high-risk,
low-benefit product, struck me and plenty of other doctors as silly from the
moment it was introduced. Arguments for the diphtheria vaccine were vitiated
by epidemics during the past 15 years which showed the same death rate and
the same severity of illness in those who were vaccinated vs. those who were
not vaccinated. As for smallpox, even the government finally gave up that
vaccine in 1970, and I gave up on the polio vaccine when Jonas Salk showed
that the best way to catch polio in the United States was to be near a child
who recently had taken the Sabin vaccine. But the tetanus vaccine exercised
a hold on me for a much longer time. As you point out, I gave up belief in
this vaccine in stages. For a while, I still held onto the notion that farm
families and people who work around stables should continue to take tetanus
shots. But in spite of my early indoctrination with fear of "rusty nails,"
in recent years, I have developed a greater fear of the hypodermic needle.
My reasons are:
1) Scientific evidence shows that too-frequent tetanus boosters actually may
interfere with the immune reaction.
2) There has been a gradual retreat of even the most conservative
authorities from giving tetanus boosters every one year to every two years
to every five years to every 10 years (as now recommended by the American
Academy of Pediatrics), and according to some, every 20 years. All these
numbers are based on guesses
rather than on hard scientific evidence.
3) There has been a growing recognition that no controlled scientific study
(in which half the patients were given the vaccine and the other half were
given injections of sterile water) has ever been carried out to prove the
safety and effectiveness of the tetanus vaccine. Evidence for the vaccine
comes from epidemiologic studies
which are by nature controversial and which do not satisfy the criteria for
4) The tetanus vaccine over the decades has been progressively weakened in
order to reduce the considerable reaction (fever and swelling) it used to
cause. Accompanying this reduction in reactivity has been a concomitant
reduction in antigenicity (the ability to confer protection). Therefore,
there is a good chance that today's tetanus vaccine is about as effective as
5) Until the last few years, government statistics admitted that 40 percent
of the child population of the U.S. was not immunized. For all those
decades, where were the tetanus cases from all those rusty nails?
6) There now exists a growing theoretical concern which links immunizations
to the huge increase in recent decades of auto-immune diseases, e.g.,
rheumatoid arthritis, multiple sclerosis, lupus erythematosus, lymphoma, and
leukemia. In one case, Guillain-Barre paralysis from swine flu vaccine, the
relationship turned out to be more than just theoretical.
In preparing my courtroom testimony on behalf of a child who allegedly was
brain-damaged as a result of the DPT (diphtheria, pertussis, tetanus)
vaccine, I reviewed the prescribing information (package insert) for the
Connaught Laboratories product which was administered to this child. The
1975 and.1977 package insert information which measured seven-and-a-half
inches long listed three scientific references in support of the
indications, contraindications, warnings, cautions, and adverse reactions to
this vaccine. By 1978, the length of the insert had grown to 13 1/2 inches,
and the number of scientific references had increased to 11. By 1980, the
package insert was 18 inches long, and the references numbered 14. Of those
newly-added references, seven (three from U.S. medical journals and four
from foreign medical journals) dealt specifically with reactions to the
tetanus DPT portion of the (toxoid) vaccine.
An article in the Archives of Neurology (1972) described brachial plexus
neuropathy (which can lead to paralysis of the arm) prom tetanus toxoid Four
patients who received only tetanus toxoid noticed the onset of limb weak
ness from six to 21 days after the inoculation. A 1966 article published in
the Journal of the American Medical Association reports the first case of
"Peripheral Neuropathy .following Tetanus Toxoid Administration." A 23-year-
old white medical student received an injection of tetanus toxoid into his
right upper arm after an abrasion of the right knee while playing tennis.
Several hours later, he developed a wrist drop of his right
hand. He later suffered from complete motor and sensory paralysis over the
distribution of the right radial nerve (one of the major nerves innervating
the arm and hand) One month later, no residual motor or sensory deficit
could be found.
Reference is made to an article in the Journal of Neurology, 1977, entitled
"Unusual Neurological Complication following Tetanus Toxoid Administration."
The author reports a 36-year-old female who received tetanus toxoid in her
left upper arm following a wound to her finger. Five days later, she noticed
a weakness first of the right, and then of the left and later of both legs.
She complained of dizziness, instability, lethargy, chest discomfort,
difficulty in swallowing, and inarticulate speech. S staggered when she
walked, and she could take only a few steps. Her EEG showed some
abnormalities. After a month, she was discharged without neurologic
disturbance, but she continued to feel weak and anxious. Examinations during
the next 11 months showed continued emotional instability and some
paresthesias (numbness and tingling) in the extremities. The medical
diagnosis was "a rapidly progressing neuropathy with involvement of cranial
nerves, myelopathy, and encephalopathy."
The Journal of Allergy and Clinical Immunology, 1973, carried an article
entitled "Hypersensitivity to Tetanus Toxoid," and in a volume entitled
"Proceedings of the II
International Conference on Tetanus" (published by Hans Huber, Bern,
Switzerland, 1967), an article appeared entitled "Clinical Reactions to
A 44-year-old article in the Journal of the American Medical Association
(1940) was entitled "Allergy Induced by Immunization with Tetanus Toxoid."
That same year, an article in the British Medical Journal reported on
"Anaphylaxis (a form of shock) following Administration of Tetanus Toxoid."
In 1969, a German medical journal reported a case of paralysis of the
recurrent laryngeal nerve (the nerve to the voicebox) after a booster
injection of tetanus toxoid. The patient developed hoarseness and was unable
to speak loudly, but the nerve paralysis subsided completely after
approximately two months.
Should your doctor reassure you that tetanus vaccine is completely safe, or
that "the benefits outweigh the risks," or that you should have a shot "just
in case," why not share these citations with him?