Any good books that talk about tetanus?

[TonyaW]

I have read about this so much. I have many books that talk about vaccinations and most of them are of anti vaccine books. Despite what I have read, a couple of the books written by Romm and Mendohlson seem to imply that tetanus vaccination is something that they would recommend. Not the booster but I guess the initial shots.

So now I am considering getting my unvaxed son the DT shot. I feel so much anxiety every time he gets hurt. He is a boy and has now had three fairly serious injuries, one which involved a cat bite puncture wound. I have felt immense anxiety about tetanus.

My doctor does not push vaccines and even said that the risk of tetanus is low, and that he has never seen it in his 30 year career. However, honestly I don't know for sure if this is because of vaccination or because it really is rare in general. There too many view points that make sense on both sides. My doc does recommend the vaccine and feels it is safe.

I would like to find a book that really talks a lot about tetanus the disease and the vaccine information.

Books that I really dislike are those that only tell the evils of vaccination and only the evils of not vaccinating. I really liked Romm's book for this reason.

[Marnica]

Dr. Mendelshon spoke out againt the tetanus vaccine in his publishings, stating the vaccine was no more effective than "tap water" and that it had never been studied for efficacy. The CDC even admits as much in the pink book.

I know of no such book that addresses only tetanus. Honestly I think you should go ahead and get your son the DT. The amount of anxiety you are experiencing about this must be quite overwhelming. If you feel he is protected, than perhaps you will feel better when he sustains an injury. I think all of the less bais books (I say less because NO book is 100% bias free either way. The author always has his/her opinions) address tetanus in a matter of fact way, indicating that it is an extremely rare disease and that the most important factors to preventing it are proper wound care.

[TonyaW]

From which pink book are you referring?

Also, in Dr Tennpenny's book, there were reported cases of tetanus in those who had been previously and fully vaccinated and had the highest antibody levels who contracted the worst cases of tetanus.

I am not look for just a book on tetanus, but I would like one that discusses the topic more in depth. the books I have seem to skim over the topic.

[Delicateflower]

It's a publication of the CDC, containing all the basic information about vaccines and vaccine preventable diseases

The Pink Book provides physicians, nurses, nurse practitioners, physician assistants, pharmacists, and others with the most comprehensive information on vaccine-preventable diseases.

Typical chapters include a description of the disease, pathogenesis, clinical features, laboratory diagnosis, medical management, epidemiology, risk factors, trends in the United States, vaccine details, vaccination schedule and use, contraindications and precautions to vaccination, adverse reactions following vaccination, vaccine storage and handling, and reference or publications.

The appendices are a wealth of reference materials including: age and interval table, discontinued vaccines, ingredients table, warning signs for vaccine storage, comforting restraints, site-maps, skills-checklist, vaccine administration guide, etc.

You can find it online, here:
http://www.cdc.gov/vaccines/pubs/pinkbook/default.htm

Almost all reported cases of tetanus are in persons who have
either never been vaccinated, or who completed a primary
series but have not had a booster in the preceding 10 years.

After a primary series (three properly spaced doses of
tetanus toxoid in persons 7 years of age and older, and four
doses in children younger than 7 years of age) essentially all
recipients achieve antitoxin levels considerably greater than
the protective level of 0.1 IU/mL.

Efficacy of the toxoid has never been studied in a vaccine
trial. It can be inferred from protective antitoxin levels that
a complete tetanus toxoid series has a clinical efficacy of
virtually 100%; cases of tetanus occurring in fully immu
nized persons whose last dose was within the last 10 years
are extremely rare.

[MyBoysBlue]

This would be the CDC's Pink Book I assume she is quoting. The Chapter on Tetanus.

http://www.cdc.gov/vaccines/pubs/pin...k-chapters.htm

[Marnica]

I was referring to what the pinkbook says about the vaccine never having been studied for efficacy:

Efficacy of the toxoid has never been studied in a vaccine trial.

[Delicateflower]

The full quote is

Efficacy of the toxoid has never been studied in a vaccine
trial. It can be inferred from protective antitoxin levels that
a complete tetanus toxoid series has a clinical efficacy of
virtually 100%; cases of tetanus occurring in fully immu
nized persons whose last dose was within the last 10 years
are extremely rare.

What they're saying is that in the 40's when they started using it they didn't set up a trial with two groups of people, one vaccinated and one unvaccinated and then see who got more cases. From my limited internet 'research' I understand that in 1941 they decided to immunize all US troops, and only 12 cases were reported from all troops in the whole world over the course of the war. And all 12 cases were un-immnized or incompletely immunized soldiers. That's a lot lower than was expected. They didn't develop the ability to do titers until sometime after 1944, but they have since shown that high titers are conferred by vaccination and that vaccinated people have a drastically drastically reduced rate of tetanus.

http://books.google.com/books?id=jDu...page&q&f=false

Think of seatbelts in cars. They didn't choose a group of people, give half of them seatbekts and see how many died, but by comparing people who had them and people who didn't you can see that the ones who didn't have them die more often.

[ema-adama]

I found this PDF. On page 8 it specifies more details about the US troops in WWII.

It states that there were 11 cases of tetanus in US troops during 2nd world war.

6 had received no immunization, of those 6, 2 died and 4 recovered.
5 had received 3 vaccines. Of the two who did not get a booster post injury, both died. Of the three who did get a booster post injury, none died.

Rather mixed results.

I still worry about tetanus. And I still read up about it as I try to weigh up the risk and benefit of the DT and the disease tetanus. I have not been able to understand yet why the vaccine would confer protection when the disease itself does not. For now I clean all wounds.

OP - I find it helpful to read old medical texts about tetanus. They go into more specifics about what types of wounds resulted in tetanus, and just how rare it is in children.

As with all vaccine decisions, you need to make the best choice you can - the choice that leaves you the most confident to live your life.

[Delicateflower]

Originally Posted by ema-adama

I found this PDF. On page 8 it specifies more details about the US troops in WWII.

It states that there were 11 cases of tetanus in US troops during 2nd world war.

6 had received no immunization, of those 6, 2 died and 4 recovered.
5 had received 3 vaccines. Of the two who did not get a booster post injury, both died. Of the three who did get a booster post injury, none died.

Rather mixed results.

Why do you say mixed? It is incredibly conclusive. Out of 2.7 million hospitalizations for wounds or injuries, only 12 contracted tetanus - really only six because six were unimmunized. And none of those six immunized soldiers who got a booster post-injury died, while the ones who didn't died. Did you see how many of the troops of the army that wasn't immunized died of tetanus? My internet 'research' is only coming up with 'numerous' because they're all quoting that DoD report, I'm sure the number is out there.

No wonder they didn't do further trials after that incredible success. I doubt an ethics committee would have permitted them to do it with such strong evidence of efficacy already.

[Turquesa]

I think that Dr. Bob Sears does a good job explaining all of the VADs, including tetanus, in The Vaccine Book. From my understanding, (and I'm seriously all ears if I'm wrong), it's a fairly low-risk vaccine. We chose to get it for our LOs, although are adult boosters aren't up to date.

[Otto]

Originally Posted by ema-adama

I have not been able to understand yet why the vaccine would confer protection when the disease itself does not.

This is almost certainly a result of the potency of the toxin, which can kill you in amounts too small to even provoke an immune response in the first place. Its habit of abiding in the nervous system may also shield it from the immune system. The toxoid vaccine, on the other hand, targets an immune response by design.

[ema-adama]

Originally Posted by Otto

This is almost certainly a result of the potency of the toxin, which can kill you in amounts too small to even provoke an immune response in the first place. Its habit of abiding in the nervous system may also shield it from the immune system. The toxoid vaccine, on the other hand, targets an immune response by design.

Thanks for that. On the surface that makes sense to me.

I guess my next question would be. Tetanus seems to have a +-30% fatality rate. It doesn't kill every person, even if they have not been vaccinated. So what mechanism is protecting people who recover from tetanus without being vaccinated? And do you think they would develop antibodies if they survived?

Also, why in your opinion, do some fully vaccinated people die of tetanus (when antibody titres are withing the range given to be protective - or vaccinated within the last 10 years)?

[Otto]

Originally Posted by ema-adama

Tetanus seems to have a +-30% fatality rate. It doesn't kill every person, even if they have not been vaccinated. So what mechanism is protecting people who recover from tetanus without being vaccinated?

Aside from supportive care and appropriate prophylaxis, including TiG when indicated? I don't really know that there is any particular innate mechanism. (The U.S. CFR in 1947 was 91%.) Severity of the disease is obviously modulated by the amount of toxin received, and I believe the path it takes to the CNS is a factor as well. (You might want to check out this article; I haven't had the time to really go over it and the references.)

Originally Posted by ema-adama

And do you think they would develop antibodies if they survived?

I don't recall having read of this being observed. There have been some reports of unimmunized people showing up with antibodies, which are thought to have resulted from enteric colonization with C. tetani, so it's not outside the realm of possibility or anything.

Originally Posted by ema-adama

Also, why in your opinion, do some fully vaccinated people die of tetanus (when antibody titres are withing the range given to be protective - or vaccinated within the last 10 years)?

Even deaths aside, I think it's an open question why the fully vaccinated sometimes develop severe tetanus. You've probably seen this; the 1992 report here is also of interest. But aside from being pretty sure that these holes originate on the immune side rather than the pathogen side, I wouldn't venture an opinion.

[Delicateflower]

Originally Posted by ema-adama

(when antibody titres are withing the range given to be protective - or vaccinated within the last 10 years)?

For a start, just because you have boosters every ten years doesn't mean your titers are high enough to protect you. Some people's levels decline faster than others. That's why everyone gets an antibody shot after a serious wound. It explained that in the paragraph from the pink book which I had to delete to bring the quote down to 100 words. You should read the pink book, it explains both this and the reason why tetanus infection doesn't always confer immunity.

And I can imagine situations where the infection is overwhelming. Serious burns, for example. If you had huge third degree burns it wouldn't only be tetanus that would be stressing your body. Or people with AIDS or a compromised immune system. Vaccination works through your immune system. If your immune system can't react well, it won't fight the infection.

[ema-adama]

Originally Posted by Otto

Aside from supportive care and appropriate prophylaxis, including TiG when indicated? I don't really know that there is any particular innate mechanism. (The U.S. CFR in 1947 was 91%.) Severity of the disease is obviously modulated by the amount of toxin received, and I believe the path it takes to the CNS is a factor as well. (You might want to check out this article; I haven't had the time to really go over it and the references.)

There is a relationship between the site of injury and type of injury and the outcome (although I did not see what else this study was looking at - I have only had time to skim it. It looks interesting).

I don't recall having read of this being observed. There have been some reports of unimmunized people showing up with antibodies, which are thought to have resulted from enteric colonization with C. tetani, so it's not outside the realm of possibility or anything.

I remember reading somewhere about naturally acquired immunity and kind of dismissed it as some sort of fringe phenomenon not relevant to the discussion. The consensus is overwhelmingly in favour of no natural immunity. So I found it interesting reading this: Naturally acquired immunity to tetanus toxin in an isolated community. I guess that is what you were referring to? I wonder what the incidence of infant mortality due to tetanus was in this community, and overall number of cases of tetanus in this community prior to their moving to Israel.

Even deaths aside, I think it's an open question why the fully vaccinated sometimes develop severe tetanus. You've probably seen this; the 1992 report here is also of interest. But aside from being pretty sure that these holes originate on the immune side rather than the pathogen side, I wouldn't venture an opinion.

I would agree that the anomaly is more likely to be in the patient/care of the patient rather than in the pathogen.