Tetanus is a rare but deadly disease with only about 40 cases seen per year in the US. THis year, 2 cases came through our emergency department, both seen by the same resident, a colleague of mine. Think about those odds. less than 1 case per state per year, and my classmate has seen 2 cases in one year. What did those cases have in common? As with all tetanus cases, lack of immunity. Immunity comes from immunization, as in Tetanus booster shots every 10 years or sooner for a dirty wound. The schedule also differs depending on whether or not you’ve ever had your original series of three primary vaccinations as a child (or adult).

So why did our ED see 5% of all the tetanus cases in the US this past year? The high concentration of Amish in the area also means a high number of unvaccinated children.

On another note, Americans over the age of 60 are at SEVEN times greater risk of tetanus than those less than sixty. Why? Lack of booster immunizations. The CDC states that

“Every contact with the health-care system, particularly among older adults and IDUs, should be used to review and update vaccination status as needed.”

I gave out three tetanus boosters today, and inquired about many, many more. The emergency department is a prime location for screening for outdated tetanus boosters. The majority of the time, in fact EVERY time until today, patients are happy to get their booster sensing on some level how imporant it is.

SO I was a little shocked when I asked a man in his 70s when his last tetanus booster was. “Back when I was in the Army,” he said, which was over 30 years ago. “How about if we give you a booster today?” “No thanks, I’ll be OK,” he replied.

Well, fortunately, thanks to a litte EBM (Evidenced Based Medicine) knowledge…which just means that I was paying attention in lecture one day…I was able to inform him that the majority of tetanus cases in teh US are in people over the age of 60 due to lack of booster immunization. It described my patient exactly. He was more than happy to wait for one after hearing this.