Insufficient Tetanus Vaccination Status in Patients with Chronic Leg Ulcers

Abstract

Background: Tetanus disease is caused by Clostridium tetani and is one of the most common infectious diseases worldwide. Despite international recommendations for patients with a chronic leg ulcer, there has been a distinctive lack of protection provided by vaccination for these patients in the past decades. Methods: Within the context of our prospective clinical investigation we consecutively determined the concentrations of immunoglobulin G antibodies against C. tetani in 100 patients with a chronic leg ulcer between January 2005 and November 2006. Results: A total of 38 patients were male, and 62 were female. Their mean age was 71 years (25–94). In a total of 47% (n = 47; 13 male, 34 female, mean age: 76 years) of the patients, insufficient immunoglobulin G antibody concentrations were detected. Particularly the subanalysis indicated an insufficient tetanus protection provided by vaccination in 70% of the people aged ≧80 years. Conclusion: A chronic wound, e.g. in the form of a leg ulcer, is known as a potential entrance for C. tetani. Unlike acute wounds, however, it is hardly ever considered to be a reason for assessment of the tetanus immune status. The results of our investigation clarify that particularly elderly people suffering from a leg ulcer have to be tested for tetanus protection provided by vaccination more strictly than ever, and if necessary, vaccinations have to be renewed.

Diabetic Foot Wounds: Which Patients are More Prone to Tetanus?

“…There are numerous studies in the literature concerning immunity rates against tetanus in various patient populations, but studies including patients suffering from DFW or chronic leg ulcers are very limited. Korber et al [5] reported that 47% of all patients suffering from chronic leg ulcers showed an insufficient tetanus antibody concentration, and their subanalysis revealed that 70% of patients aged over 80-year-old had insufficient protection against tetanus. In the present study, we found that sufficient protection rates in DFW patients decreased with increasing age, as in the aforementioned study.…”

“…Gangrenous tissue is another factor that is frequently seen in DFWs and predisposes patients to tetanus [3,4] . Over 70% of all diagnosed tetanus infections occur in people over 50 years of age, and 11% of all tetanus cases were found in patients suffering from chronic wounds [5] .…”

Generalised tetanus in a patient with a chronic ulcerated skin lesion

“…16 Up to 47% of patients with chronic leg ulcers-which affect 3-5% of people over 65 17 -have insufficient IgG concentrations for immunity, rising to 70% in patients aged over 80. 9 Consequently, chronic ulcerated wounds should be considered as prone to tetanus, and recommendations highlight the importance of prophylaxis. 9 11 15 18 Tetanus after surgery is uncommon.…”

Are current UK tetanus prophylaxis procedures for wound management optimal?

“…A number of studies have assessed adult tetanus seroprotection rates (antitoxin levels of >0.1 or >0.15 IU/ml) in countries with comprehensive vaccination programmes: protective antitoxin levels were seen in 72% to 90% of patients in the USA,20 21 80% in England and Wales22 and 64% in Belgium 23. Of note was the observation that the degree of protection was lower in older people (31% to 60% in individuals >60 years20 21 22 23 24 in the USA, UK and Belgium), in women (64% to 86% in the US studies20 21) and in immigrants (52% to 75% in the US studies20 21 and 45% to 52% in the Belgian study23). …”