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November 14, 1980

Tetanus and the Institutionalized Elderly-Reply

Author Affiliations

St Paul-Ramsey Medical Center University of Minnesota Medical School St Paul

JAMA. 1980;244(19):2159-2160. doi:10.1001/jama.1980.03310190015009

In Reply.—  We did not comment in our recent article about tetanus immunization for the institutionalized elderly, because we endorse the Advisory Committee on Immunization Practices' (ACIP) position that "[tetanus] immunization is a universal necessity."1No specific information about the incidence of tetanus in nursing home residents is available from national epidemiologic data. Attempts to estimate the occurrence of this disease in nursing homes by extrapolation from incidence data are likely to be inaccurate, because they ignore qualitative differences between the health of nursing home residents and the general population. For example, infection of chronic skin ulcerations and gangrenous extremities—conditions surely more common in nursing home residents—accounted for 5% of cases of tetanus in one recent study.2We do not believe that the relatively low incidence of tetanus can appropriately be used in formulations designed to assess the cost-effectiveness of immunization. Cost-benefit studies are both inaccurate and difficult