Fwd: Tetanus vaccine reactions

[Guest guest]

>

>Here is some specific information on Tetanus (and Diptheria) vaccines -

not

>something I want to risk!

>http://www.medscape.com/other/MMWR/1996/sep/rr4512/rr4512.html

> [bannerLink]

>

> [Folio-MMWR]

>

>Update: Vaccine Side Effects, Adverse Reactions, Contraindications, and

>Precautions

>

>Recommendations of the Advisory Committee on Immunization Practices

(ACIP)

>

>Authors: Tuttle, M.D., T. Chen, M.D., M.A., C.

>Hadler, M.D., C. , M.D., M.P.H., J. Terracciano, D.O.,

>M.P.H., Epidemiology and Surveillance Division, National Immunization

>Program, in collaboration with the Advisory Committee on Immunization

>Practices (ACIP).

>

>[back] Summary: This report provides updated information concerning the

>potential adverse events associated with vaccination for hepatitis B,

>poliomyelitis, measles, mumps, diphtheria, tetanus, and pertussis. This

>information incorporates findings from a series of recent literature

>reviews, conducted by an expert committee at the Institute of Medicine

>(IOM), of all evidence regarding the possible adverse consequences of

>vaccines administered to children. This report contains modifications

to the

>previously published recommendations of the Advisory Committee on

>Immunization Practices (ACIP) and is based on an ACIP review of the IOM

>findings and new research on vaccine safety. In addition, this report

>incorporates information contained in the " Recommendations of the

Advisory

>Committee on Immunization Practices: Use of Vaccines and Immune

Globulins in

>Persons with Altered Immunocompetence " (MMWR 1993;42[No. RR-4]) and the

> " General Recommendations on Immunization: Recommendations of the

Advisory

>Committee on Immunization Practices (ACIP) " (MMWR 1994;43[No. RR-1]).

Major

>changes to the previous recommendations are highlighted within the

text, and

>specific information concerning the following vaccines and the possible

>adverse events associated with their administration are included:

hepatitis

>B vaccine and anaphylaxis; measles vaccine and a) thrombocytopenia and

>possible risk for death resulting from anaphylaxis or disseminated

disease

>in immunocompromised persons; diphtheria and tetanus toxoids and

pertussis

>vaccine (DTP) and chronic encephalopathy; and tetanus-toxoid-containing

>vaccines and a) Guillain-Barr=E9 syndrome, brachial neuritis, and c)

>possible risk for death resulting from anaphylaxis. These modifications

will

>be incorporated into more comprehensive ACIP recommendations for each

>vaccine when such statements are revised. Also included in this report

are

>interim recommendations concerning the use of measles and mumps

vaccines in

>a) persons who are infected with human immunodeficiency virus and

persons

>who are allergic to eggs; ACIP is still evaluating these

recommendations.

>[MMWR 45(No. RR-12):inclusive page numbers, 1996]

>

><SNIP>

>

>Preparations Containing Diphtheria Toxoid and Tetanus Toxoid

>

>The only contraindication to tetanus and diphtheria toxoids is a

history of

>a neurologic or severe hypersensitivity reaction following a previous

dose.

>Vaccination with tetanus and diphtheria toxoids is not known to be

>associated with an increased risk of convulsions. Local side effects

alone

>do not preclude continued use. If an anaphylactic reaction to a

previous

>dose of tetanus toxoid is suspected, intradermal skin testing with

>appropriately diluted tetanus toxoid may be useful before a decision is

made

>to discontinue tetanus toxoid vaccination [86]. In one study, 94 of 95

>persons with histories of anaphylactic symptoms following a previous

dose of

>tetanus toxoid were nonreactive following intradermal testing and

tolerated

>further tetanus toxoid challenge without incident [86]. One person had

>erythema and induration immediately following skin testing, but

tolerated a

>full IM dose without adverse effects. Mild, nonspecific skin-test

reactivity

>to tetanus toxoid, particularly if used undiluted, appears to be fairly

>common. Most vaccinees develop inconsequential cutaneous delayed

>hypersensitivity to the toxoid. Although very rare, severe

hypersensitivity

>re-actions may occur after receipt of tetanus-toxoid-containing

vaccines;

>these reactions can be life-threatening [5].

>

>Persons who experienced Arthus-type hypersensitivity reactions or a

>temperature of >103 F (>39.4 C) following a prior dose of tetanus

toxoid

>usually have high serum tetanus antitoxin levels and should not be

given

>even emergency doses of Td more frequently than every 10 years, even if

they

>have a wound that is neither clean nor minor.

>

>If a contraindication to using tetanus-toxoid-containing preparations

exists

>for a person who has not completed a primary series of tetanus toxoid

>immunization and that person has a wound that is neither clean nor

minor,

>only passive immunization should be given using tetanus IG (TIG).

>

> On the basis of a) a report of a 42-year-old man who had GBS on three

> separate occasions after receipt of tetanus toxoid and evidence

that a

> vaccine-induced immunologic response can cause GBS, IOM concluded that

> tetanus-toxoid-containingvaccines can trigger the onset of GBS in

adults.

> GBS can be a life-threatening disease. Persons who have a history of

GBS

> associated with a particular vaccine may be at increased risk for

> recurrent GBS after subsequent doses of that vaccine [5]. However, in

a

> study in which an estimated 1.2 million doses of tetanus-containing

> toxoid were administered to persons >18 years of age, two cases of GBS

> were expected by chance alone during the 6 weeks after vaccination,

and

> only one case was reported (CDC, unpublished data). This finding

suggests

> that the risk for GBS after administration of tetanus toxoid is

extremely

> low.

>

> No increased risk for GBS has been observed with the use of DTP in

> children. In a study of 0.7 million children of preschool-ages who

were

> vaccinated with DTP during a 7-year period, three cases of GBS were

> expected by chance alone during the 6 weeks after vaccination, and

only

> two cases were reported [17].

>

> Because tetanus vaccination has been associated rarely with recurrence

of

> GBS, the decision to administer additional doses of

> tetanus-toxoid-containing vaccine to persons who have had GBS within 6

> weeks after receiving tetanus toxoid should be based on the benefits

of

> subsequent vaccination and the risk for recurrence of GBS. For

example,

> vaccination is usually justified for children whose primary

immunization

> schedules are incomplete (i.e., fewer than three doses have been

> received); but routine booster vaccination probably is not indicated

for

> adults who have received three or more doses.

>

> Vaccination with tetanus-toxoid-containing vaccines has been

associated

> with brachial neuritis in adult vaccinees, with a relative risk of

5-10

> in comparison with the population-based background incidence and a

> 1-month attributable incidence of approximately one-half to one case

per

> 100,000 recipients of tetanus toxoid [5].

>

>Although no evidence exists that tetanus and diphtheria toxoids are

>teratogenic, waiting until the second trimester of pregnancy to

administer

>Td is a reasonable pre-caution for minimizing any concern about the

>theoretical possibility of such reactions.