Tetanus and diphtheria immunity among females in the United States: Are recommendations being followed?

Objective: The purpose of this study was to examine prevalence and factors associated with tetanus and diphtheria immunity among women in the United States. Study design: Sera from 9411 female participants from the third National Health and Nutrition Examination Survey were tested for diphtheria and tetanus antitoxin. Interview information for adult women was analyzed to examine associations with immunity. Results: Fifty-seven percent of the female subjects who were greater than or equal to6 years old were positive for diphtheria, and 64% of the female subjects for tetanus anti-toxin. Among women greater than or equal to20 years old, only 41% of the women were protected against both antigens. Older age, birth outside the United States, and less education was associated with lower immunity. Markers for contact with the health care system were not related to higher immunity. Conclusion: More than one half of US women greater than or equal to20 years old who were tested were not protected fully against diphtheria and tetanus. All physicians, including obstetricians and gynecologists who may be the sole medical providers for women, should be familiar with the current Advisory Committee on Immunization Practices recommendations regarding tetanus and diphtheria toxoid booster vaccines. (C) 2004 Elsevier Inc. All rights reserved.