Serologic Immunity to Tetanus in the United States, National Health and Nutrition Examination Survey, 2015-2016

• Published in: Clinical infectious diseases Vol. 78; no. 2; pp. 470 - 475
• Main Authors: Bampoe, Valerie D, Brown, Nicole, Deng, Li, Schiffer, Jarad, Jia, Lily Tao, Epperson, Monica, Gorantla, Yamini, Park, So Hee, Ao, Jingning, Acosta, Anna M, Hariri, Susan
• Format: Journal Article
• Language: English
• Published: United States 17-02-2024
• Subjects: Adult; Aged; Antibodies, Bacterial; Child; Humans; Immunization, Secondary; Nutrition Surveys; Tetanus - epidemiology; Tetanus - prevention & control; Tetanus Toxoid; United States - epidemiology; Vaccination; United States; microsphere-based multiplex antibody capture assay; national health and nutrition and examination survey (NHANES); MMACA; tetanus sero-immunity; ELISA
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/cid/ciad598

Tetanus, a life-threatening infection, has become rare in the United States since introduction of tetanus toxoid-containing vaccines (TTCVs), recommended as a childhood series followed by decennial boosters beginning at age 11-12 years; vaccination uptake is high in children but suboptimal in adults. The objective of this study was to estimate the prevalence of sero-immunity to tetanus among persons aged ≥6 years in the United States and to identify factors associated with tetanus sero-immunity. Understanding population protection against tetanus informs current and future vaccine recommendations.
Anti-tetanus toxoid antibody concentrations were measured for participants of the 2015-2016 National Health and Nutrition Examination Survey (NHANES) aged ≥6 years for whom surplus serum samples were available using a microsphere-based multiplex antibody capture assay. Prevalence of sero-immunity, defined as ≥0.10 IU/mL, was estimated overall and by demographic characteristics. Factors associated with tetanus sero-immunity were examined using multivariable regression.
Overall, 93.8% of the US population aged ≥6 years had sero-protection against tetanus. Prevalence of sero-immunity was above 90% across racial/ethnic categories, sex, and poverty levels. By age, ≥ 90% had protective sero-immunity through age 69 years, but prevalence of sero-immunity declined thereafter, with 75.8% of those aged ≥80 years having protective sero-immunity. Older age (adjusted prevalence ratio [aPR]: 0.89, 95% confidence interval [CI]: .85-.92) and being born outside the United States (aPR: 0.96, 95% CI: .93-.98) were significantly associated with lower prevalence of sero-immunity.
The majority of the US population has vaccine-induced sero-immunity to tetanus, demonstrating the success of the vaccination program.