Abstract 9: Incidence of Tetanus and Diphtheria Compared to Vaccine Schedule

Incidence of tetanus and diphtheria in relation to adult vaccination schedules Slifka AM, Park B, Gao L, et al. Clin Infect Dis. 2020;ciaa017. doi: 10.1093/cid/ciaa017. [published online ahead of print, 2020 Feb 25]

SUMMARY: 

The current recommendation in many countries, including the United States and Canada, is to provide routine adult booster vaccination of tetanus and diphtheria (Td) every 10 years. However, the World Health Organization (WHO) does not recommend these boosters, and some countries, such as the UK, do not give routine booster shots. 

• This was an observational cohort study over 15 years (2001–2016).
• The primary outcome was WHO case reports on the incidence of tetanus and diphtheria in 31 North American and European countries with differing booster recommendations.
• The study evaluated group 1 (Td vaccination every 5 to 20 years) vs. group 2 (no routine Td vaccination).
• The study included more than 11 billion person-years of incidence data. 
• No decline in tetanus rates was observed among all countries.

PMID: 32095828

EDITOR'S COMMENTARY - Ken Milne, MD
A previous study from the United States showed that tetanus immunity lasted about 30 years after childhood (Hammarlund et al., 2016). This is another line of evidence that we do not need to be boosting the public with Td every 10 years. It supports the WHO’s position and the UK’s practice of not giving routine Td booster vaccination. The data suggest that we over-vaccinate in some cases (Td) but under-vaccinate in other situations (influenza). However, this study does not negate the recommendation for pregnant women to get Tdap for pertussis protection, as recommended by the CDC. 

BOTTOM LINE: It is perhaps time to revisit the recommendation of routine adult Td booster vaccinations.