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October 2, 1967

Excessive Use of Tetanus Toxoid Boosters

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.