To the Editor.
—The report of the two cases of tetanus occurring in Kansas in 19931 serves as an important reminder that this disease, rare in the United States, still occurs; that primary immunization is not universal; that appropriate wound management is necessary for secondary prevention; and that older Americans are particularly vulnerable. The epidemiology of tetanus in the United States has remained fairly stable over the last decade with about 50 to 60 cases yearly, with higher attack rates and higher mortality rates among older Americans, many of whom never received primary immunization.2,3Using formal decision analysis, we found that primary immunization in childhood and a single tetanus booster for elderly adults is a cost-effective alternative to the decennial booster policy for primary prevention of tetanus.4 While the costs (charges) of care for two persons with tetanus may fund as many as 90 000 doses of
Balestra DJ, Littenberg B. Tetanus Immunization in Adults. JAMA. 1994;272(24):1900. doi:10.1001/jama.1994.03520240028033