PUBLIC HEALTH and pediatric care in a given region, especially with respect to artificial active immunization, may be uniquely assessed by a knowledge of the level of circulating tetanus antitoxin. This antibody is unique because it is the only one of preventive significance that has never been shown to be naturally acquired and hence artificial and natural immunity are not confounded. For this reason it is probably the single most important antibody to assay in a general serological survey of the immunization status of population groups.
The availability of military recruits' sera in the Reference Serum Bank of the World Health Organization (WHO) has afforded us the opportunity to compare the immune status with respect to tetanus of the population of a group of northern and southern states. The object of this paper is to present the results of this comparison. At the present time, state and municipal health departments
Levine L, Wyman L. Tetanus Immunity in the North and South. JAMA. 1964;187(7):518–520. doi:10.1001/jama.1964.03060200050009