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June 24, 1950


Author Affiliations

National Institutes of Health, Bethesda, Md.

JAMA. 1950;143(8):761. doi:10.1001/jama.1950.02910430053024

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To the Editor:—  In the otherwise excellent clinical note on "Postoperative Tetanus" by Henry J. Van Duine in The Journal (143:175 [May 13] 1950) there apparently is an error in the last paragraph, page 176, in the sentence reading "A year later immunity can be boosted by either toxoid or toxin." Tetanus toxin is not used in clinical medicine for the reason that the administration of a dose of toxin sufficiently large to produce an adequate response would be extremely hazardous.I suspect the author may have intended to use the word "antitoxin" instead of "toxin." For those who have had basic immunity to tetanus established, toxoid is much to be preferred to antitoxin in subsequent immunization. The immune response from a booster dose of toxoid is higher and more lasting, and serum reactions are avoided. Toxoid was used exclusively for increase of immunity on exposure in the armed

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