Shots for Tetanus: Immunity for All

In blood-colored movies and in the flesh, Dr. Norman A. Christensen of the Mayo Clinic urged his colleagues at the A.M.A. to embark on a crusade. What he wants is nothing less than an all-out campaign to eradicate tetanus in the U.S. by having every man, woman and child immunized with toxoid and periodic booster shots.

There have been 256 tetanus deaths in the U.S. this year, and Dr. Christensen argued that almost all of them were avoidable. For proof, he cited the record of the U.S. armed forces in World War II: among 12 million in uniform, there were only 16 confirmed cases of tetanus (with six deaths).

Difficult Choice. Tetanus bacteria lurk in sewage and soil, in dust and rust. They can enter the human body through any penetrating wound, through the unhealed navel of the newborn, and through drug addicts' contaminated dope. There is so little that even the best of medical centers can do once the disease has developed, Dr. Christensen insists prevention is the only reliable cure. Tetanus toxoid is cheap and safe; it rarely causes unwanted reactions. It should first be given in a course of three shots paced a month apart, he says. There should be a booster a year later and every five years thereafter.

If an emergency patient has had the toxoid within a couple of years, said Dr. Christensen, all he needs is an immediate booster. But if he has never had toxoid, or is unconscious and cannot answer questions, the doctor has a difficult choice. He can give toxoid, which takes a while to build up immunity and may work too slowly. Or he can give tetanus antitoxin, which confers brief but prompt immunity. Trouble is, the antitoxin, almost always prepared from the blood of horses, carries a heavy risk of serum sickness, which can be as deadly as tetanus.

Expensive Escape. Every year, said Dr. Christensen, about 500,000 Americans get a shot of horse-serum antitoxin. Some 25,000 get a bad reaction, and about 20 die. Tetanus experts see an escape from such dangers--at a price. Two West Coast companies, Cutter Laboratories and Hyland Laboratories, are extracting tetanus antibody from human volunteers in the form of immune globulin. But the price of one shot of human serum extract ranges from $7.50 to $11.50, whereas the horse serum costs less than $2.00. And even where price is no problem, an overriding handicap remains: human globulin is likely always to be in short supply.

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