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

Background 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.Methods 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.Results 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.Conclusions The majority of the US population has vaccine-induced sero-immunity to tetanus, demonstrating the success of the vaccination program. Overall, a higher proportion of the US population had sero-protection against tetanus compared to previously reported estimates. Prevalence of tetanus sero-immunity was high across all race and ethnic groups. There were notable differences in prevalence of tetanus sero-immunity by age.

Automated summary

This study estimated the prevalence of tetanus sero-immunity among the US population and identified factors associated with tetanus sero-immunity. The majority of the US population has vaccine-induced sero-immunity to tetanus, demonstrating the success of the vaccination program.