geoffrey modest medical blogs

  A recent article reviewed the resurgence of tetanus in the US that is associated with inadequate tetanus vaccine administration: see tetanus resurgence JAMA2026 in dropbox, or doi:10.1001/jama.2026.9347 A few background issues: -- tetanus is ubiquitous in nature -- clinical tetanus develops in humans when the spores of the Clostridium tetani bacteria germinate in anaerobic environments; the spores release the tetanus toxin tetanospasmin     -- the typical scenario is having a contaminated or deep wound providing anaerobic conditions     -- the diagnosis of tetanus is a clinical one: there are no diagnostic tests that support or rule out tetanus -- this toxin affects the sympathetic nervous system by interfering with the release of neurotransmitters, resulting in sustained muscular contraction and spasms -- this effect involves many different muscles, leading to respiratory failure from chest wall spasms, diaphragmatic dysfunction, laryngospasm and airway obs...

  A really huge database assessment found no benefit of giving adults tetanus/diphtheria vaccine boosters if they completed their childhood vaccines (see   tetanus booster adults CID2021  in dropbox, or DOI: 10.1093/cid/ciaa017   ).    Details :  -- observational cohort study using secondary sources from the World Health Organization (WHO) and World Bank, from 2001-17 -- main outcomes assessed: differences in reported tetanus and diphtheria clinical infections globally, stratified by whether adult booster vaccines were given or not as recommended by the individual country's vaccine schedule Results :  Tetanus -- for 11.6 billion person-years of data from 31 North American and European countries, the tetanus incidence range per 1 million person-years:      -- for those countries recommending adult vaccination (Group 1):           -- North America (3 countries): 0.09-0.42   ...