Fwd:TETANUS VACCINE - ADVERSE REACTION

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>Here is some more info and I'll pass along more as I find it.

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>> JAMA, The Journal of the American Medical Association

>> Wednesday, May 25, 1994

>> Vol. 271, No. 20, ISSN: 0098-7484

>>

>> Adverse reactions to tetanus toxoid. (Questions and

Answers)

>> R. Agnew Roland W. Sutter

>>

>> Q A patient, previously immunized in the military, received a

tetanus

>> toxoid booster vaccination that resulted in a painful, erythematous

>> upper extremity, with several days of fever and lassitude. If he has

a

>> penetrating injury in the future, what should be done?

>>

>> R. Agnew, MD

>>

>> Fort Myers, Fla

>>

>> A Although few details of this patient's adverse event following

>> vaccination are available, in general, adverse reactions following

>> tetanus toxoid may be influenced by the number of previous doses, the

>> toxoid dosage, the route and method of administration, and the

presence

>> of adjuvants and/or other antigens (such as diphtheria toxoid) in the

>> preparation chosen. The most common adverse event following tetanus

>> booster vaccination (in 50% to 85% of recipients) is a local reaction

>> characterized by pain and tenderness at the injection site, less

>> frequently (in 20% to 30%) followed by edema and erythema, and rarely

>> (less than 2%) marked by considerable swelling.[1] Several studies

have

>> found a direct correlation between the circulating tetanus antitoxin

>> level and the degree of local reaction. A few reports have described

>> massive local reactions (eg, associated with swelling from elbow to

>> shoulder), occurring primarily in persons receiving multiple booster

>> doses of toxoid. Generally, these reactions begin within 2 to 8 hours

>> after the injection. Circulating antibody apparently forms complexes

>> with the deposited toxoid to induce an inflammatory response (Arthus

>> reaction, type II hypersensitivity). Fever can accompany a local

>> response (in 0.5% to 7%), particularly when local reaction is marked

or

>> antitoxin levels are high, or both. However, a temperature higher

than

>> 39[degrees]C is rare, and other systemic symptoms, such as headache

or

>> malaise, are rarely reported. The preservative used in tetanus toxoid

>> (ie, thimerosal) can lead to delayed-type hypersensitivity, while

>> serum-sicknesslike illnesses appear to be rarely associated with

>> tetanus toxoid.

>>

>> This patient most likely experienced an Arthus-type reaction,

>> probably caused by multiple previous doses of the toxoid that

resulted

>> in high levels of circulating tetanus antitoxin. Assessment of

tetanus

>> antitoxin levels could substantiate the diagnosis and assist future

>> management in the event of a penetrating injury. If high levels of

>> tetanus antitoxin are found, the patient should be protected for at

>> least 10 years, and tetanus toxoid should not be administered during

>> this period. If tetanus antitoxin levels are low, the patient should

be

>> evaluated by an immunologist or allergist; tetanus immunoglobulin

could

>> be used in the event of a tetanus-prone wound to provide short-term

>> protection until tetanus toxoid can be safely administered. To

prevent

>> such reactions, tetanus toxoid should not be administered routinely

>> more frequently than every 10 years as recommended by the Advisory

>> Committee on Immunization Practices.[2]

>>

>> To better monitor the risk and nature of serious adverse events

>> following vaccination (including vaccination with tetanus toxoid),

>> physicians are requested to report these events to the Vaccine

Adverse

>> Event Reporting System. Report forms and additional information on

>> reporting may be obtained by telephoning (800) 822-7967.

>>

>> Roland W. Sutter, MD, MPH & TM

>>

>> National Immunization Program

>>

>> Centers for Disease Control and Prevention

>>

>> Atlanta, Ga [1.] Wassilak SGF, Orenstein WA, Sutter RW. Tetanus

>> toxoid. In: Plotkin SA, Mortimer EA, eds. Vaccines. 2nd ed.

>> Philadelphia, Pa: WB Saunders Co. In press. [2.] Centers for Disease

>> Control. Diphtheria, tetanus, and pertussis: recommendations for

>> vaccine use and other preventive measures. MMWR Morb Mortal Wkly Rep.

>> 1991;40(RR-10):1-28.

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