Geraldine M. McQuillan, PhD; Deanna Kruszon-Moran, MS; Adamadia Deforest, PhD; Susan Y. Chu, PhD, MSPH; Melinda Wharton, MD, MPH
Acknowledgment: The authors thank Ms. Alicia Spadaccino, MT (ASCP), for providing the diphtheria test results.
Requests for Single Reprints: Geraldine M. McQuillan, PhD, Division of Health Examination Statistics, National Center for Health Statistics, 6525 Belcrest Road, Room 1000, Hyattsville, MD 20782; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. McQuillan and Ms. Kruszon-Moran: Division of Health Examination Statistics, National Center for Health Statistics, 6525 Belcrest Road, Room 1000, Hyattsville, MD 20782.
Dr. Deforest: Department of Pathology and Laboratory Medicine, St. Christopher's Hospital for Children, Erie Avenue at Front Street, Philadelphia, PA 19134-1095.
Drs. Chu and Wharton: National Immunization Program, Centers for Disease Control and Prevention, Corporate Square Facility, Building 12, Corporate Square Boulevard, Atlanta, GA 30329.
Author Contributions: Conception and design: G.M. McQuillan, D. Kruszon-Moran, M. Wharton.
Analysis and interpretation of the data: G.M. McQuillan, D. Kruszon-Moran, S.Y. Chu, M. Wharton.
Drafting of the article: G.M. McQuillan, D. Kruszon-Moran, A. Deforest, S.Y. Chu.
Critical revision of the article for important intellectual content: G.M. McQuillan, D. Kruszon-Moran, A. Deforest, S.Y. Chu, M. Wharton.
Final approval of the article: G.M. McQuillan, D. Kruszon-Moran, A. Deforest, S.Y. Chu, M. Wharton.
Provision of study materials or patients: G.M. McQuillan.
Statistical expertise: G.M. McQuillan, D. Kruszon-Moran.
Administrative, technical, or logistic support: A. Deforest.
Collection and assembly of data: G.M. McQuillan.
Serologic data on diseases that are preventable by vaccine are useful to evaluate the success of immunization programs and to identify susceptible subgroups.
To provide national estimates of immunity to diphtheria and tetanus by measurement of serum antibody levels.
Examination of data from the Third National Health and Nutrition Examination Survey, a representative cross-sectional sample of the U.S. population.
89 randomly selected locations throughout the United States.
18 045 persons 6 years of age or older who were examined from 1988 to 1994.
Serum samples obtained at a single time point were tested for diphtheria and tetanus antitoxin.
Overall, 60.5% of Americans 6 years of age or older had fully protective levels of diphtheria antibody (≥ 0.10 IU/mL) and 72.3% had protective levels of tetanus antibody (>0.15 IU/mL). Ninety-one percent of Americans 6 to 11 years of age had protective levels of both diphtheria and tetanus antibody; this proportion decreased to approximately 30% among persons 70 years of age (29.5% for diphtheria and 31.0% for tetanus). Adult Mexican-Americans were slightly less likely to have protective levels of antibody to both toxins. Only 47% of persons 20 years of age or older had levels that were protective against both diseases, and only 63% of adults who were protected against tetanus were also protected against diphtheria.
A substantial proportion of adults in the United States do not have antibody levels that are protective against diphtheria and tetanus. In addition, although the recommended vaccine is a combination of tetanus and diphtheria, only 63% of adults with protective antibody to tetanus also had protective antibody to diphtheria.
Although immunization against diphtheria and tetanus is nearly universal during childhood, immunity wanes as people age. The prevalence of immunity in adults is unknown.
According to the Third National Health and Nutrition Examination Survey (NHANES III), only 60% of the total adult population had serologic protection against diphtheria; 72% were protected against tetanus. By age 70, only 30% of adults had serologic immunity to either disease.
Booster immunization every 10 years is important to protect adults against diphtheria and tetanus.
Table. Prevalence of Immunity to Diphtheria and Tetanus by Demographic Characteristics, Third National Health and Nutrition Examination Survey, 1988–1994
Age-specific prevalence of immunity to tetanus and diphtheria by sex, Third National Health and Nutrition Examination Survey, 1988–1994.
Age- and race/ethnicity-specific prevalence of immunity to diphtheria, Third National Health and Nutrition Examination Survey, 1988–1994.
Age- and race/ethnicity-specific prevalence of immunity to tetanus, Third National Health and Nutrition Examination Survey, 1988–1994.
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McQuillan GM, Kruszon-Moran D, Deforest A, et al. Serologic Immunity to Diphtheria and Tetanus in the United States. Ann Intern Med. 2002;136:660–666. doi: 10.7326/0003-4819-136-9-200205070-00008
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Published: Ann Intern Med. 2002;136(9):660-666.
Infectious Disease, Prevention/Screening, Vaccines/Immunization.
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