[mamakay]

3 dose DTaP coverage hangs out aroud 95%<br><a href="http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/G/coverage.pdf" target="_blank">http://www.cdc.gov/vaccines/pubs/pin...G/coverage.pdf</a><br><br>
2,000 unvaxed kids a year under 1 each year...<br><br>
Till age 4 will be 8,000...<br><br>
At age 8, that would be 16,000 if they remain unvaxed...some will vax for school, though, leaving the religious/philo exemptors.<br><br>
Either way, I wouldn't say unvaxed kids parctically don't exist.

 

[dymanic]

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<div>Originally Posted by <strong>mamakay</strong> <a href="/community/forum/post/10314383"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
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<div>Originally Posted by <strong>CDC</strong></div>
<div style="font-style:italic;">(TIG) for postexposure prophylaxis in wound treatment, and c) improved wound care management</div>
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None of which is going to do Nathan any good unless Mum takes him to the doc. Ditto antibiotics.<br><br><div style="margin:20px;margin-top:5px;">
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<div>Originally Posted by <strong>CDC</strong></div>
<div style="font-style:italic;">increased rural to urban migration, with consequent decreased exposure to tetanus spores, may have contributed to the decline in tetanus mortality noted during the first half of the century.</div>
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Makes perfect sense. Millions of people, living out their lives in artificial environments made of concrete and steel, seldom get anywhere near anything you'd really call "soil", and the same is likely to be true of any type of object they're likely to get poked with. The risk to Nathan would be considerably less had he been injured on a bolt sticking out of a fifth-floor railing in his New York apartment building. But he wasn't. It was "<i>a sharp old metal thing down in the garden buried in the grass</i>", remember?<br><br><div style="margin:20px;margin-top:5px;">
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<div>Originally Posted by <strong>mamakay</strong></div>
<div style="font-style:italic;">Why do you think people with diabetes are more prone to get tetanus?</div>
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I wouldn't be so quick to assume that it was due to anaerobic conditions caused by poor circulation. In addition to being statistically just as prone to injury as anyone else (and maybe a little bit more), diabetics don't even have to experience a puncture wound, because they are especially prone to ulcers and lesions on the feet which can provide a point of entry for the bacterium.<br><br><div style="margin:20px;margin-top:5px;">
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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">Since when does "attack rate" only refer to contagious diseases?</td>
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Here, we're talking about a risk factor that's virtually impossible to track. For tetanus infection to occur, the bacterium requires a point of entry. This is most often provided by a puncture wound. It doesn't have to be big, it just needs to be kinda deep. A sufficiently deep splinter has been known to do it. Of all the children in the U.S. who recieved such a wound, what percentage were untreated? Until you know that, I don't see how you can talk about attack rate.<br><br>
There are basically two things that will render a person's chances of getting tetanus effectively zero. One is to get vaccinated. The other is to not get poked with anything, especially not anything that's been in contact with soil. Nathan is out of the box on both of those scores. There are several other things that can also reduce those chances, at least the chances of dying from tetanus: antibiotics; post-exposure prophylaxis; proper wound care. The only one possible without professional intervention is the wound care. I don't know if anyone else here is prepared to make specific recommendations on that and accept a share of the responsibility for the outcome, but I know I'm not.

 

[Gitti]

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<div>Originally Posted by <strong>nathansmum</strong> <a href="/community/forum/post/10304726"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">We're non vaxxers, done heaps of research, and don't worry about things usually...</div>
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How is your son doing?

 

[mamakay]

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<div>Originally Posted by <strong>dymanic</strong></div>
<div style="font-style:italic;">I wouldn't be so quick to assume that it was due to anaerobic conditions caused by poor circulation. In addition to being statistically just as prone to injury as anyone else (and maybe a little bit more), diabetics don't even have to experience a puncture wound, because they are especially prone to ulcers and lesions on the feet which can provide a point of entry for the bacterium.</div>
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The ulcers are caused by poor circulation, too.<br><br><a href="http://orthoinfo.aaos.org/topic.cfm?topic=A00148" target="_blank">http://orthoinfo.aaos.org/topic.cfm?topic=A00148</a><br><div style="margin:20px;margin-top:5px;">
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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">Minor injuries become major emergencies before you know it. <b>With a diabetic foot, a wound as small as a blister from wearing a shoe that's too tight can cause a lot of damage. Diabetes decreases your blood flow, so your injuries are slow to heal. When your wound is not healing, it's at risk for infection.</b> As a diabetic, your infections spread quickly.</td>
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[dymanic]

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<div>Originally Posted by <strong>mamakay</strong> <a href="/community/forum/post/10323066"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">The ulcers are caused by poor circulation, too.</div>
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Right. That was pretty much my point.<br><br><div style="margin:20px;margin-top:5px;">
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<div>Originally Posted by <strong>orthoinfo</strong></div>
<div style="font-style:italic;">Diabetes decreases your blood flow, so your injuries are slow to heal.</div>
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But that's not the same as saying "<i>diabetes decreases your blood flow, thereby creating an anaerobic environment</i>".<br><br>
The intuitive assumption underlying the comment (by Gitti) that initiated this exchange ("<i>tetanus can only grow on dead tissue. Not even inside your body, deep inside, where there is blood present (not bleeding, just present) tetanus can not grow</i>") is that an anaerobic environment can't exist where oxygenated blood is present. You haven't explicitly subscribed to this notion, but your attempts to lend it support (both with the above snippet and with another on the first page: "<i>Poor circulation prevents nutrients and oxygen from reaching the cells to help heal wounds and infections</i>") suggest that you are also inclined to accept this assumption. But it is <i>free oxygen</i> that inhibits the growth of the bacteria, and oxygen in blood is bound to hemoglobin.

 

[mamakay]

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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">You haven't explicitly subscribed to this notion, but your attempts to lend it support (both with the above snippet and with another on the first page: "Poor circulation prevents nutrients and oxygen from reaching the cells to help heal wounds and infections") suggest that you are also inclined to accept this assumption.</td>
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I'm supporting the assumption that part of why kids don't generally get tetanus is because of their good circulation.<br>
Are you still going to argue that you can't think of why that has anything to do with it?

 

[dymanic]

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<div>Originally Posted by <strong>mamakay</strong> <a href="/community/forum/post/10325778"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">I'm supporting the assumption that part of why kids don't generally get tetanus is because of their good circulation.</div>
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In the strictest sense, I suppose that's true. But it seems like a sort of bassackwards way of looking at things, and implies that good circulation offers some affirmative protection against tetanus aside from being a good indicator that diabetes is not a factor -- a conclusion which quickly fails on the simple observation that the vast majority of tetanus cases <i>aren't</i> diabetics, and therefore may be assumed to have normal circulation.<br><br><div style="margin:20px;margin-top:5px;">
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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">Are you still going to argue that you can't think of why that has anything to do with it?</td>
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I'll continue to dispute the implication that it has anything directly to do with creating an anaerobic environment, yes.

 

[mamakay]

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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">a conclusion which quickly fails on the simple observation that the vast majority of tetanus cases aren't diabetics, and therefore may be assumed to have normal circulation.</td>
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The highest incidence is in those over 60.<br>
Do you think poor circulation could have anything to do with that (along with declining immune function)?<br><br>
Or do you dispute that those over 60 are more prone to have poor circulation?<br><br><div style="margin:20px;margin-top:5px;">
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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">I'll continue to dispute the implication that it has anything directly to do with creating an anaerobic environment, yes.</td>
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<img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/headscratch.gif" style="border:0px solid;" title="headscratch"><br><br>
I'm a little confused by your wording.<br><br>
Are you saying poor circulation can't lead to the kinds of lingering wounds that can house anaerobic bacteria? The logical extension of that would be that <i>excellent</i> circulation makes one <i>less</i> inclined to have those kinds of lingering wounds.

 

[anewmama]

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<div>Originally Posted by <strong>dymanic</strong> <a href="/community/forum/post/10311801"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">What I find most pertinent is that while incidence in unvaccinated kids is very low, in vaccinated kids, it's <i>nonexistent</i>.</div>
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Can you please provide the research/stats/statistics on that on CDC or some other standard website?

 

[dymanic]

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<div>Originally Posted by <strong>mamakay</strong> <a href="/community/forum/post/10330421"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">The highest incidence is in those over 60.<br>
Do you think poor circulation could have anything to do with that (along with declining immune function)?</div>
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No, I don't. It's pretty clear from the statistics that vax status is the most significant factor as far as incidence is concerned, and coverage among the elderly is poorer than in other groups. The case fatality rate (roughly 50% in elderly patients) is surely influenced by declining immune function, but also represents a lower tolerance for the toxins produced by the bacteria (one of which is, by weight, among the most potent toxins known). I wouldn't be quick to dismiss the role of immunosenescence, but as tetanus vaccination is highly efficient by comparison with some other vaccines, it seems clear to me that this is not the main cause for the bias in rates of incidence toward the elderly.<br><br><div style="margin:20px;margin-top:5px;">
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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">Are you saying poor circulation can't lead to the kinds of lingering wounds that can house anaerobic bacteria?</td>
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Yes. Tetanus requires a wound. It doesn't require that the wound be "lingering", just that it be deep enough to create an anaerobic environment. The incubation period is 3-21 days, the average being 8 days. I don't know how you'd define "lingering", but to me, it's more than 8 days. By itself, poor circulation doesn't lead to wounds, lingering or otherwise. (I'll grant that a wound which remained open for a long time could provide a longer window of opportunity for the bacteria to enter, but <i>statistically</i> my money would be on entry most often occurring right away.)<br><br><div style="margin:20px;margin-top:5px;">
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<div>Originally Posted by <strong>anewmama</strong></div>
<div style="font-style:italic;">Can you please provide the research/stats/statistics on that on CDC or some other standard website?</div>
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This pdf has information on age distribution:<br><a href="http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/tetanus.pdf" target="_blank">http://www.cdc.gov/vaccines/pubs/pin...ds/tetanus.pdf</a><br><br>
Here's an interesting tidbit:<br>
Only 4 of 520 persons dying from tetanus (0.7%) had a history of at least 3 TT doses<br><a href="http://cdc.confex.com/cdc/nic2005/techprogram/paper_7813.htm" target="_blank">http://cdc.confex.com/cdc/nic2005/te...paper_7813.htm</a>

 

[nathansmum]

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<div>Originally Posted by <strong>Gitti</strong> <a href="/community/forum/post/10321689"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">How is your son doing?</div>
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Fine thanks! Sorry, we have been away for 4 days. The wound has remained clean and did not get infected. It was not what I would call a deep wound (maybe one millimetre?), but more like a clean slice, so a little more than a scratch. It had sealed up by the end of the day and was clean and just a light red line remains. I think what concerned me more and made me (and others think of tetanus) was the "rusty and metal" bit of the injury yet it seems this is not adding any more tetanus risk than say a stick protruding from the ground that may cause a deep scratch which I can't imagine many people would think of going off to get a jab for (thinking adults here since most I know do vaccinate their kids yet I don't know of adults getting a booster unless they get a puncture wound that requires medical attention)?). FWIW, the "thing" was not buried in the ground, had been tossed on the surface into long grass (which had been cut short not long ago, so no idea how it got there) - so yes it was old and quite likely containing spores anyway, but was not dirt covered).<br><br>
Thanks for the discussion all.

 

[Irishcupcake]

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<div>Originally Posted by <strong>dymanic</strong> <a href="/community/forum/post/10335146"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">Here's an interesting tidbit:<br>
Only 4 of 520 persons dying from tetanus (0.7%) had a history of at least 3 TT doses<br><a href="http://cdc.confex.com/cdc/nic2005/techprogram/paper_7813.htm" target="_blank">http://cdc.confex.com/cdc/nic2005/te...paper_7813.htm</a></div>
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Hmm...so, the elderly, who we already know to be at a higher risk, happened to not be vaxed...and were more likely to die. I really don't see anything to that argument.<br>
520 people died in 29 years? I don't see how that's "severe and often fatal." 500 people die every year from listeria and most people have never heard of it!

 

[mamakay]

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<div class="smallfont" style="margin-bottom:2px;">Quote:</div>
<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">No, I don't. It's pretty clear from the statistics that vax status is the most significant factor as far as incidence is concerned, and coverage among the elderly is poorer than in other groups.</td>
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I don't doubt that vax status plays a part.<br><br>
But why again is it that diabetics are more tetanus prone than other people?<br><br><div style="margin:20px;margin-top:5px;">
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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">By itself, poor circulation doesn't lead to wounds, lingering or otherwise.</td>
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What causes "diabetic foot"?<br>
BTW..I'm looking for tetanus epidemiology in unvaccinated populations or the prevaccine era.<br>
Surely someone somewhere at some time has done that. If the incidence in kids was/is higher than in the elderly there, then you're (probably) right. If the incidence was/is higher in the elderly, then I'm (probably) right.<br><br>
Agreed?

 

[mamakay]

<div style="margin:20px;margin-top:5px;">
<div class="smallfont" style="margin-bottom:2px;">Quote:</div>
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<div>Originally Posted by <strong>mamakay</strong> <a href="/community/forum/post/10314669"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">3 dose DTaP coverage hangs out aroud 95%<br><a href="http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/G/coverage.pdf" target="_blank">http://www.cdc.gov/vaccines/pubs/pin...G/coverage.pdf</a><br><br>
2,000 unvaxed kids a year under 1 each year...<br><br>
Till age 4 will be 8,000...<br><br>
At age 8, that would be 16,000 if they remain unvaxed...some will vax for school, though, leaving the religious/philo exemptors.<br><br>
Either way, I wouldn't say unvaxed kids parctically don't exist.</div>
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I think I did my math wrong there....<br><br>
With a 4 million birth cohort...how many kids is 5% of that (for one year)?

 

[dymanic]

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<div>Originally Posted by <strong>nathansmum</strong> <a href="/community/forum/post/10339480"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">The wound has remained clean and did not get infected. It was not what I would call a deep wound (maybe one millimetre?), but more like a clean slice, so a little more than a scratch. It had sealed up by the end of the day and was clean and just a light red line remains.</div>
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Sure doesn't sound like the sort of wound that generally raises a lot of concern about tetanus... I mean, a <i>millimeter</i>? Heck, before you know it, that guy's going to be doing jumps off the shed roof with his skateboard. You're gonna need a lot more pep-talking then.<br><br><div style="margin:20px;margin-top:5px;">
<div class="smallfont" style="margin-bottom:2px;">Quote:</div>
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<div>Originally Posted by <strong>Irishcupcake</strong></div>
<div style="font-style:italic;">so, the elderly, who we already know to be at a higher risk, happened to not be vaxed...and were more likely to die. I really don't see anything to that argument.</div>
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Not sure that really is an argument. It's a simple observation. The argument (which you seem to have overlooked) is that the elderly are at higher risk <i>because</i> they are less likely to be vaxed.<br><br><div style="margin:20px;margin-top:5px;">
<div class="smallfont" style="margin-bottom:2px;">Quote:</div>
<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">520 people died in 29 years? I don't see how that's "severe and often fatal."</td>
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In this context, "severe and often fatal" refers to the clinical course of infection, not the likelihood of becoming infected in the first place. The case fatality rate for tetanus in the U.S. these days is about 11%. During 1998-2000, it was 18%. Don't know if <i>you'd</i> call that "severe"; some would. In Turkey, it's closer to 60%, which puts it in the same neighborhood as the CFR for ebola in Sudan.<br><br><div style="margin:20px;margin-top:5px;">
<div class="smallfont" style="margin-bottom:2px;">Quote:</div>
<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">500 people die every year from listeria and most people have never heard of it!</td>
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Just out of curiosity, how many people have to die each year from something before you'd consider it reasonable to use phraseology like "severe and often fatal"? Do you consider lysteria to meet the requirement?<br><br><div style="margin:20px;margin-top:5px;">
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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">
<div>Originally Posted by <strong>mamakay</strong></div>
<div style="font-style:italic;">But why again is it that diabetics are more tetanus prone than other people?</div>
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Because it can fulfill the bacteria's first requirement by providing an opening. Everybody else has to get unlucky enough to get poked with something -- but that can happen to a diabetic, too, so they face the same risk as everybody else PLUS the extra risk produced by their disease. We covered this.<br><br><div style="margin:20px;margin-top:5px;">
<div class="smallfont" style="margin-bottom:2px;">Quote:</div>
<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">What causes "diabetic foot"?</td>
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Poor circulation. But you can't extrapolate poor circulation in diabetics to poor circulation in non-diabetics. I mean, there's poor circulation and then there's <i>poor circulation</i>. Lots of people with "poor circulation" don't develop open sores as a result. No opening, no tetanus.<br><br><div style="margin:20px;margin-top:5px;">
<div class="smallfont" style="margin-bottom:2px;">Quote:</div>
<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">I'm looking for tetanus epidemiology in unvaccinated populations or the prevaccine era.</td>
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I haven't found anything that shows age-specific incidence in the pre-vaccination era either; but, yes, I'm willing to predict that if we find it, we'll see that incidence among children was higher then.<br><br><div style="margin:20px;margin-top:5px;">
<div class="smallfont" style="margin-bottom:2px;">Quote:</div>
<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">With a 4 million birth cohort...how many kids is 5% of that (for one year)?</td>
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I think it ends up being a semantic quibble over the definition of "practically".

 

[mamakay]

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<div>Originally Posted by <strong>dymanic</strong></div>
<div style="font-style:italic;">Poor circulation. But you can't extrapolate poor circulation in diabetics to poor circulation in non-diabetics.</div>
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But you can extrapolate this one increased risk of poor circulation in diabetics to poor circulation in the elderly.<br>
Or rather, it seems appropriate to me.<br><br>
What about poor circulation in the elderly <i>doesn't</i> put them at an increased tetanus risk compared to diabetics?<br><div style="margin:20px;margin-top:5px;">
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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">Lots of people with "poor circulation" don't develop open sores as a result.</td>
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Yes, lots of elderly people and diabetics don't develop tetanus.<br>
I'm not sure what your point is there, though....<br><br><div style="margin:20px;margin-top:5px;">
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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">I haven't found anything that shows age-specific incidence in the pre-vaccination era either; but, yes, I'm willing to predict that if we find it, we'll see that incidence among children was higher then</td>
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That the incidence in children was higher than it was in the elderly?<br>
I'm not sure we're discussing the same thing, always, dymanic.<br>
When I said:<br><br><div style="margin:20px;margin-top:5px;">
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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">
<div>Originally Posted by <strong>me</strong></div>
<div style="font-style:italic;">If the incidence in kids was/is higher than in the elderly there, then you're (probably) right. If the incidence was/is higher in the elderly, then I'm (probably) right.</div>
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..I was saying that I think that simply being physiologically older puts one at an increased risk of developing tetanus, irrespective of vaccination status. I do think the vaccine is effective, also, and I agree that older folks might have never been vaccinated. But I think poor circulation adds an additional risk (along with declining immune system functioning) to that age group.<br>
Are we arguing about the same thing, or do I need to back up more and explain my position further?<br><br><div style="margin:20px;margin-top:5px;">
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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">I think it ends up being a semantic quibble over the definition of "practically".</td>
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How many is it that don't (practically or otherwise) exist?

 

[dymanic]

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<div>Originally Posted by <strong>mamakay</strong> <a href="/community/forum/post/10342585"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">But you can extrapolate this one increased risk of poor circulation in diabetics to poor circulation in the elderly.</div>
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Sure. You can treat "poor circulation" as a gradient, with the most severe vascular complications of diabetes at the far end. But starting from "normal circulation" and moving toward that far end, you cross a binary threshold: the point at which it begins to result in open sores. Whatever decrease in circulation exists below that threshold can be ignored as far as tetanus incidence is concerned, because it isn't going to impact that directly. If you want to talk about <i>indirectly</i>, then fine, but it's going to get hairy. You're going to be talking about increased risk for accidents, and diabetes (as well as plain old age itself) can impact that in lots of ways: poorer vision, poorer sense of balance...<br><br><div style="margin:20px;margin-top:5px;">
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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">Yes, lots of elderly people and diabetics don't develop tetanus.</td>
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Right. They don't develop open sores or get poked with anything.<br><br><div style="margin:20px;margin-top:5px;">
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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">That the incidence in children was higher than it was in the elderly?</td>
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Demography is a science in itself. In considering the risk factors for tetanus, you might begin with vax status, or you might begin by considering the risk factors for certain types of injury -- but you can't ignore either one, no matter where you start. Are children and the elderly equally at risk for puncture wounds or deep lacerations? I don't feel qualified to answer that, but I'd be willing to guess that they're not.<br><br><div style="margin:20px;margin-top:5px;">
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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">But I think poor circulation adds an additional risk (along with declining immune system functioning) to that age group.</td>
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Immune function as it relates to tetanus infection is a bit of a special case. As with any infectious disease, immune response does not take place until the pathogen has proliferated enough to become visible to the immune system. With tetanus, the problem is that one of the toxins produced by the bacterium is lethal to humans in doses as small as 2.5 nanograms per kilogram of body weight, and is produced (in vitro) in amounts up to 5 to 10% of the bacterial weight. For this reason, previous infection is not associated with immunity to the disease; if the illness progresses far enough to trigger an immune response, it kills you.<br><br><div style="margin:20px;margin-top:5px;">
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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">How many is it that don't (practically or otherwise) exist?</td>
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Okay, OKAY. Sheesh. I noticed your math error when you first put it up, and roughly calculated that I had used "practically nonexistent" to refer to maybe several million kids. That goes beyond what I'd accept as hyperbole, but rather than retract, I chose to let your math error stand. I might be able to justify a thing like that if it were somebody else, but you deserve better (after all, you have dutifully pointed out <i>every single error</i> you've ever caught me making, as far as I can tell, and I owe it to you to reciprocate). I wish I had a more dignified way out of it, but I don't see any choice but to apologize for my crime of omission and retract my "<i>practically nonexistent</i>". It was a poor choice of words, and I give up on trying to defend it. I don't know precisely how many U.S. children are unvaccinated against tetanus. I think there's about eighty million kids altogether, so if it's five percent, that would be roughly four million. I can't stretch "practically nonexistent" to fit around that.

 

[mamakay]

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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">Immune function as it relates to tetanus infection is a bit of a special case. As with any infectious disease, immune response does not take place until the pathogen has proliferated enough to become visible to the immune system</td>
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<i>Humoral</i> immune response.<br><br>
The immune system just clears a lot of stuff out (I think maybe through the lymphatic ststem) as "gunk", too. What all is going on there is getting into the mysterious netherworlds of immunology, though. But we encounter and process all kinds "stuff" that we never develop a humoral memory for. Tetanus <i>spores</i> are certainly among them.<br><div style="margin:20px;margin-top:5px;">
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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">For this reason, previous infection is not associated with immunity to the disease; if the illness progresses far enough to trigger an immune response, it kills you.</td>
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That might or might not be true. Antibodies to tetanus toxin have been found in unvaccinated people, with an increasing incidence of seropositivity with increasing age.<br>
Also, google "subacute tetanus".<br><br>
Not that I'm personally "banking on" any of that...but it's all probably a bit more compliated than generally thought.

 

[dymanic]

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<div>Originally Posted by <strong>mamakay</strong> <a href="/community/forum/post/10345592"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">Antibodies to tetanus toxin have been found in unvaccinated people, with an increasing incidence of seropositivity with increasing age.</div>
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I don't know all of the original sources for that, but at least some appear to have problems with things like the stringency of the assay methods or the accuracy with which immunization histories were determined. As for seropositivity increasing in correlation with age, it looks like some studies reached the opposite conclusion:<br><br>
"<i>If natural immunity is of epidemiological significance in developing countries, then the percentage of immune persons should increase with age. This is not the case (Misra & Rao 1988, Ray et al. 1978). The data for healthy unimmunized persons do not show a clear dependency between age and the presence of tetanus antibodies (Metzkin & Regev 1985).</i>"<br><a href="http://pendellmedical.com/pdf/IBMod3e.pdf" target="_blank">http://pendellmedical.com/pdf/IBMod3e.pdf</a><br><br>
"<i>Studies in African schoolchildren (Rey, 1981), Indian military recruits (Menon et al. 1976), persons taking care of horses (Lahiri, 1939), pregnant women in New Guinea (MacLennan et al. 1965), and healthy persons in Upper Volta (Breman et al. 1981), have demonstrated that populations in developing countries with a high level of exposure to tetanus spores usually lack tetanus neutralizing antitoxins. Even if asymptomatic colonization and infection of the intestine with tetanus organisms occurs in some areas of the developing world, natural immunity is not thought to have any practical importance in controlling tetanus.</i>"<br><a href="http://www.who.int/vaccines-documents/DocsPDF07/869.pdf" target="_blank">http://www.who.int/vaccines-documents/DocsPDF07/869.pdf</a><br><br><br>
Another of the weird things about tetanus is that there is no laboratory procedure for confirming infection; diagnosis is strictly clinical. The bacterium is recovered from the wound in only 30% of cases, and can also be isolated from patients who do not have the disease.

 

[mamakay]

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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">The data for healthy unimmunized persons do not show a clear dependency between age and the presence of tetanus antibodies (Metzkin & Regev 1985)."<br><a href="http://pendellmedical.com/pdf/IBMod3e.pdf" target="_blank">http://pendellmedical.com/pdf/IBMod3e.pdf</a></td>
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I'm not sure what the WHO guys are talking about there...<br>
Here' the study mentioned:<br><br><a href="http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=261948&blobtype=pdf" target="_blank">http://www.pubmedcentral.nih.gov/pic...8&blobtype=pdf</a><br><br><div style="margin:20px;margin-top:5px;">
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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">Naturally Acquired Immunity to Tetanus Toxin in an Isolated<br>
Community<br>
HAIM MATZKINt* AND SHARON REGEV</td>
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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">In Ethiopia, health services are<br>
notoriously poor. It has been estimated that there is about<br>
one physician per 100,000 people. The very small ancient<br>
Jewish community in Ethiopia has suffered from prolonged<br>
persecution and cultural isolation. This community has been<br>
deprived of the poor health services in the country, and<br>
according to our information, <b>none of the subjects included<br>
in our study had ever been attended by a physician, let alone<br>
received any injections during their lifetimes</b>.</td>
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[
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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">Although only 30% exhibited more than the accepted<br>
protective titer of 0.01 IU/ml (7), <b>the percentage of those<br>
considered protected was age dependent, increasing substantially<br>
from 10% in the first decade to an average of 29% in the<br>
11- to 60-year-old group to 63% in the group over 60 years of<br>
age.</b> Natural immunity to tetanus is gained, as in many other<br>
diseases, through adequate, repeated, and prolonged antigenic<br>
stimulation that sensitizes the immune system. <b>The<br>
opportunities for achieving immunity increase with age, and<br>
this is well reflected in our data</b>.</td>
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So that's supposed to be a study reaching the opposite conclusion?<br><br>
Here's another...<br><br><a href="http://www.ncbi.nlm.nih.gov/pubmed/6680401?dopt=AbstractPlus" target="_blank">http://www.ncbi.nlm.nih.gov/pubmed/6...t=AbstractPlus</a><br><div style="margin:20px;margin-top:5px;">
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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">Among 48 adults without a history of tetanus immunization, we found with the aid of indirect hemagglutination test 20 individuals with protective tetanus antibody titers, 23 with low levels of antitoxin (under 0,1 I.U./ml) and 5 devoid of tetanus antitoxin. In two blood samples of 99 unvaccinated children under 3 years of age (taken at 7 months intervall) 12,1% showed tetanus antitoxin in the first serum sample and 16,2% in the second sample. Protective antibody titers could be found only in 4 children in each of the first and second serum sample. <b>The data suggest a silent oral immunization by tetanus bacilli thus boosting under unhygienic conditions the tetanus immunity with advancing age</b>.</td>
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I wonder if anyone's ever looked to see if folks are ever immune to the actual bacteria. Not just the toxin, but the actual bacterial antigens...