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October 2, 1967

Excessive Use of Tetanus Toxoid Boosters

Author Affiliations

From the State Laboratory Institute, Massachusetts Department of Public Health (Drs. Edsall and Eldred, and Mr. Levine), the Children's Service, Massachusetts General Hospital and the Department of Pediatrics, Harvard Medical School (Dr. Peebles), the Department of Microbiology, Harvard School of Public Health, Boston (Dr. Edsall, and Mr. Levine), and the South Shore Medical Clinic, Norwell. Mass (Dr. Elliott).

JAMA. 1967;202(1):17-19. doi:10.1001/jama.1967.03130140075009

The prevailing tetanus antibody levels on 45 children seen for routine or emergency booster injections of tetanus toxoid were all 40 to 2,500 times above the minimum protective level. Antibody levels in 22 other patients with allergic or Arthus-type reactions to tetanus toxoid were, without exception, above the threshold of protection, and all but one were many times higher. Booster doses of tetanus toxoid are being given with unnecessary and indeed excessive frequency; continuing to do this will produce a more highly toxoid-sensitive population without adding significantly to the already high protection that this immunized population has against tetanus. It is recommended that annual routine toxoid boosters of all kinds be discontinued, that routine boosters in individuals known to have had primary immunization including a reinforcing dose be given only at ten-year intervals, and that emergency boosters be given no closer than one year apart.