Re: Tetanus incident...

[Guest guest]

Of course you're worried. But the thing is--and the doctor should know this--you

don't give tetanus shots in an " emergency " situation to those who have not been

vaccinated already. I don't have all the details on the top of my head and I'm

running out the door, but it's something to do with different kinds of tetanus

shots. Here's the link to Sheri's webpage on tetanus:

http://www.wellwithin1.com/tetanus.htm

Winnie

Tetanus incident...

Vaccinations

> I can't help but be worried, but not for the reason you think.

>

> My 6.5mo got cut with a pair of scissors this morning. (My 2yo

> did it.

> *sigh*) My husband looked at the wound at lunch, and he was

> worried about

> it, so he took to the ped. Now, our ped knows we don't

> vaccinate,

> but the cut was deep enough to need something akin to liquid

> bandage that

> would help bring the skin together as it healed.

>

> I knew the nurse was going to try and push tetanus, and I had

> told her on

> the phone, " Well, we'll take it under advisement. " I warned my

> husband

> that they'd probably try and push it, and I told him that he

> could always

> use his mother as an out. (She's allergic to the tetanus

> vaccine, so with

> that family history, I don't want to risk it.)

>

> Anyway, the doctor DID push the tetanus issue (which suprised me

> 'cause

> she's always been supportive with the others). She made my

> husband sign a

> waiver, and he didn't think to cross out the awful stuff. (You

> know, the

> " I understand that I'm putting my child at risk " stuff. Thing

> is, giving

> him the vaccine would put him at risk too.) Then she even tried

> some final

> scare tactics. " Well, you know if he gets tetanus, there's

> nothing we can

> do for him? "

>

> Now, I don't live on a farm, and the scissors were relatively

> clean. The

> wound bled enough on its own, and my baby's a healthy guy, but

> I'd be

> lying if I said I had no worries at all. I know that the risk

> of him

> getting tetanus is infinitesimal, but the doctor did a good job

> of putting

> that tiny bit of worry in the back of my head.

>

> Does anyone have any good data on the incidence of tetanus in

> the US?

> (Doesn't the CDC's website have info about the incidence of

> various

> diseases?) If we hadn't called the doctor, I wouldn't have even

> worried

> about tetanus, but now that the idea's stuck in the back of my

> mind, I

> can't help but worry that my boy's gonna be the one in whatever

> gazillion

> who develops an issue.

>

> Any resources?

>

> in IN

> Loving wife to Fred (03/18/00)

> Proud mama to:

> Abigail Frances (8/13/02, homebirth transfer)

> Frederick Leland V (7/9/05, born at home!)

> (10/30/07, born at home!)

>

[Guest guest]

Wittekind wrote:

> Then she even tried some final

>scare tactics. " Well, you know if he gets tetanus, there's nothing we can

>do for him? "

>

That's a blatant lie! I don't have a link or anything, but on a med

show I was watching the other day when they suspected tetanus, they

immediately started the treatment protocol. Even in a full blown case

the mortality rate is only like 30%. You would see symptoms a lot

sooner than that, especially because you're worried, and a good

homeopath would be able to treat it from the onset.

>Now, I don't live on a farm, and the scissors were relatively clean. The

>wound bled enough on its own, and my baby's a healthy guy,

>

All those factors give you almost NO chance of there being tetanus in

the wound. And even if there was, the blood washed it out. I've had

serious puncture wounds with DIRTY, rusty equipment and haven't been

worried (nor caught tetanus).

>Does anyone have any good data on the incidence of tetanus in the US?

>

I don't know how good this site is, but the first sentence tells you

that in the incident for the ENTIRE country is <50 incidents/year! (the

extrapolation data they provide is what they're warning you isn't

accurate, NOT the number of cases in the US)

http://www.wrongdiagnosis.com/t/tetanus/stats-country.htm Notice they

don't list ANY deaths from tetanus in the US here:

http://www.wrongdiagnosis.com/t/tetanus/deaths.htm

I hope this puts your mind at ease. I'm sure your baby will be fine.

Bobbett

[Guest guest]

,

I am sorry you are stressing over this.  I know its easier said than done, but I

would not worry about this.  I find it horrible that the dr. used that " there is

nothing we can do for him " line.  It enforces in my mind the need to find

holistic minded doctors that truly " get it " and that will respect your position

during the most challenging situations instead of using scare tactics. 

I have pasted below some info. that Sheri shared with the group a few weeks ago

when this came up... i hope you find comfort in knowing that your baby is going

to be just fine.

peace and blessings..

===================================================================

Ok, tetanus has nothing to do with rust. The rusty nail scenario

> >has to do with Cows and Horses sharing pasture. A cow can be (not

> >is) a chronic carrier of tetanus and stepping on a dropped

horseshoe

> >nail could get the bacteria deep enough without coming in contact

with oxygen.

> >

> >Tetanus is a problem on an old fashioned battlefield and during

farm

> >accidents where you are near sharp instruments and deep soil.

> >

> >Tetanus is an anaerobic bacteria, it cannot surive in the presense

> >of oxygen. If you step on a nail that has been exposed to oxygen,

> >it doesn't have tetanus on it, even if the wound doesn't bleed.

>

>

> It is not about the nail being in oxygen. The spores live out

there

> no matter what. It is about once the spores get into your body, it

> then germinates in an anaerobic area - it can't cause problems

> unless in an area without oxygen

>

> http://www.nathnac. org/travel/ factsheets/ tetanusinfo. htm

> " Tetanus spores are present in the intestine and dung of horses,

> sheep, cattle, dogs, cats, rats, guinea pigs and chickens, and are

> passed into soil via faeces, making them ubiquitous in the

> environment. The disease is acquired when material containing

tetanus

> spores contaminates a wound that could be major or minor in

severity.

> Wounds with a high risk for tetanus are those that show one or more

> of the following: devitalised tissue, deep puncture, contact with

> soil or manure, and clinical evidence of sepsis [8]. In resource-

rich

> regions of the world many cases are associated with injecting drug

> users, where the drugs, injecting equipment or puncture wound may

be

> contaminated [11,12] In anaerobic conditions spores germinate and

> tetanospasmin is produced which disseminates throughout the body

via

> the blood, leading to the clinical symptoms of tetanus [8,13]. "

>

> But the risk is way over rated.

>

> and there is no diagnostic test for tetanus so anything with

similar

> symptoms (poisonings) could be diagnosed as tetanus.

>

> >I wouldn't worry about a child getting tetanus on a playground

> >unless there were also infected cows there, or if there was

digging

> >going on deep in the soil and people weren't looking out for the

kids.]]

>

> Actually spores are everywhere, pretty much, but less of a problem

in

> colder climates.

> And the best thing you can do is clean the wound after an injury.

> Tetanus certainly is not a risk after an animal or human bite,

> cutting yourself in your house, etc.

>

 

Arianna Mojica-   (UCC 1-207/1-103) 

~~~ " All rights not demanded are presumed waived " . ~ Thurston

Tetanus incident...

I can't help but be worried, but not for the reason you think.

My 6.5mo got cut with a pair of scissors this morning. (My 2yo did it.

*sigh*) My husband looked at the wound at lunch, and he was worried about

it, so he took to the ped. Now, our ped knows we don't vaccinate,

but the cut was deep enough to need something akin to liquid bandage that

would help bring the skin together as it healed.

I knew the nurse was going to try and push tetanus, and I had told her on

the phone, " Well, we'll take it under advisement. " I warned my husband

that they'd probably try and push it, and I told him that he could always

use his mother as an out. (She's allergic to the tetanus vaccine, so with

that family history, I don't want to risk it.)

Anyway, the doctor DID push the tetanus issue (which suprised me 'cause

she's always been supportive with the others). She made my husband sign a

waiver, and he didn't think to cross out the awful stuff. (You know, the

" I understand that I'm putting my child at risk " stuff. Thing is, giving

him the vaccine would put him at risk too.) Then she even tried some final

scare tactics. " Well, you know if he gets tetanus, there's nothing we can

do for him? "

Now, I don't live on a farm, and the scissors were relatively clean. The

wound bled enough on its own, and my baby's a healthy guy, but I'd be

lying if I said I had no worries at all. I know that the risk of him

getting tetanus is infinitesimal, but the doctor did a good job of putting

that tiny bit of worry in the back of my head.

Does anyone have any good data on the incidence of tetanus in the US?

(Doesn't the CDC's website have info about the incidence of various

diseases?) If we hadn't called the doctor, I wouldn't have even worried

about tetanus, but now that the idea's stuck in the back of my mind, I

can't help but worry that my boy's gonna be the one in whatever gazillion

who develops an issue.

Any resources?

in IN

Loving wife to Fred (03/18/00)

Proud mama to:

Abigail Frances (8/13/02, homebirth transfer)

Frederick Leland V (7/9/05, born at home!)

(10/30/07, born at home!)

~~~~  " A foolish faith in authority is the worst enemy of truth. "   - Albert

Einstein, 1901 " The only safe vaccine is a vaccine that is never used " -- Dr.

A. , National Institutes of Health

www.vaclib.org 

www.909shot.com

 http://www.vacinfo.org/ 

http://forcedanarchy.blogspot.com/http://www.momtoanangel.net/ingred.htmhttp://w\

ww.vran.org/~~~~ " When we give government the power to make medical decisions for

us, we, in essence, accept that the state owns our bodies " ~U.S. Representative

Ron , MD. ~~~~ "

[Guest guest]

I know a woman who was a bio chemist and her doc and hubby talked her

into getting this shot and not only did she get MS and Lupas, she got

Tetanus. YES, TETANUS!!! Very dangerous shot.

[Guest guest]

In a message dated 5/14/2008 2:41:26 P.M. Eastern Daylight Time,

starlite@... writes:

If we hadn't called the doctor, I wouldn't have even worried

about tetanus, but now that the idea's stuck in the back of my mind, I

can't help but worry that my boy's gonna be the one in whatever gazillion

who develops an issue.

I have no resources. However, based on the what you said, I really believe

there is no chance of your baby getting tetanus.

Holly

**************Wondering what's for Dinner Tonight? Get new twists on family

favorites at AOL Food.

(http://food.aol.com/dinner-tonight?NCID=aolfod00030000000001)

[Guest guest]

Homoeopathic ledum is useful. My sons have got through over 60 years,[ & 2

cousins through about 35 years] between them, without tetanus jabs, between

them. One became brain-injured following DPT so we never gave him any more.

Years later when he recovered as much as he was going to, he was accident prone.

Still, the prognosis was that he would never walk so we can't complain - he runs

everywhere! No gluten/casein etc etc.

You can get tetanus during surgery, from an ear infection, all sorts, not just

punctures, but the most reassuring thing is, most adults don't bother with

boosters, yet I do not know anyone who ever had tetanus. I've had the proverbial

rusty " nail " in the wrist; it was a 1cm diam gaff which penetrated about a cm,

but no jabs for me. I think I just let it bleed & doused it in H2O2.

My DH was a hands on electrician/engineer & has had no jabs since about 1980. We

had a bit of a laugh @ the local med centre. I had gone in for a burn & was

offered a jab. A poster was pointed out to us which was emblazoned with TETANUS

IS A SERIOUSLY FATAL DISEASE. We both laughed in unison, as we hadn't realised

there are degrees of fatality. We both " got it " but the dr wasn't amused at our

explanation. )

From: Wittekind <starlite@...>

Subject: Tetanus incident...

Vaccinations

Date: Wednesday, May 14, 2008, 11:40 AM

I can't help but be worried, but not for the reason you think.

My 6.5mo got cut with a pair of scissors this morning. (My 2yo did it.

*sigh*) My husband looked at the wound at lunch, and he was worried about

it, so he took to the ped. Now, our ped knows we don't vaccinate,

but the cut was deep enough to need something akin to liquid bandage that

would help bring the skin together as it healed.

I knew the nurse was going to try and push tetanus, and I had told her on

the phone, " Well, we'll take it under advisement. " I warned my husband

that they'd probably try and push it, and I told him that he could always

use his mother as an out. (She's allergic to the tetanus vaccine, so with

that family history, I don't want to risk it.)

Anyway, the doctor DID push the tetanus issue (which suprised me 'cause

she's always been supportive with the others). She made my husband sign a

waiver, and he didn't think to cross out the awful stuff. (You know, the

" I understand that I'm putting my child at risk " stuff. Thing is, giving

him the vaccine would put him at risk too.) Then she even tried some final

scare tactics. " Well, you know if he gets tetanus, there's nothing we can

do for him? "

Now, I don't live on a farm, and the scissors were relatively clean. The

wound bled enough on its own, and my baby's a healthy guy, but I'd be

lying if I said I had no worries at all. I know that the risk of him

getting tetanus is infinitesimal, but the doctor did a good job of putting

that tiny bit of worry in the back of my head.

Does anyone have any good data on the incidence of tetanus in the US?

(Doesn't the CDC's website have info about the incidence of various

diseases?) If we hadn't called the doctor, I wouldn't have even worried

about tetanus, but now that the idea's stuck in the back of my mind, I

can't help but worry that my boy's gonna be the one in whatever gazillion

who develops an issue.

Any resources?

in IN

Loving wife to Fred (03/18/00)

Proud mama to:

Abigail Frances (8/13/02, homebirth transfer)

Frederick Leland V (7/9/05, born at home!)

(10/30/07, born at home!)

[Guest guest]

> Of course you're worried. But the thing is--and the doctor should know

this--you don't give tetanus shots in an " emergency " situation to those who have

not been vaccinated already. I don't have all the details on the top of my head

and I'm running out the door, but it's something to do with different kinds of

tetanus shots. Here's the link to Sheri's webpage on tetanus:

> http://www.wellwithin1.com/tetanus.htm

Apparently, the doctor told my husband that had 48hrs to get the

tetanus vaccine to " protect him " . *sigh* I'm not worried about him

anymore. He's doing great; the wound's doing fine. Now I just need to

figure out what's going on with my 2yo.

Thanks to everyone for the kind words and helpful info.

in IN

Loving wife to Fred (03/18/00)

Proud mama to:

Abigail Frances (8/13/02, homebirth transfer)

Frederick Leland V (7/9/05, born at home!)

(10/30/07, born at home!)

[Guest guest]

> I know a woman who was a bio chemist and her doc and hubby talked her

> into getting this shot and not only did she get MS and Lupas, she got

> Tetanus. YES, TETANUS!!! Very dangerous shot.

It's funny... I wouldn't touch a tetanus shot with a 10-foot pole, and I

wouldn't be concerned about skipping it. With our babies though, we seem

to worry more even when we KNOW we're right. (For instance, I wouldn't

use tylenol to lower a fever in myself, but I'd get nervous about my

baby's fever if it started getting up over 103. (I haven't had a kid with

a fever over 103 for a while, but I remember when my oldest had roseola

and a fever of 104.5, I was terrified!)

When people start playing on that " you're a bad mom 'cause you're

endangering your child " card, you can't help but have some reservations.

in IN

Loving wife to Fred (03/18/00)

Proud mama to:

Abigail Frances (8/13/02, homebirth transfer)

Frederick Leland V (7/9/05, born at home!)

(10/30/07, born at home!)

[Guest guest]

See my webpages

http://www.wellwithin1.com/tetanus.htm

very rare, treatable though not pleasant

and certainly not common on household items..........if ever.

Sheri

listowner

[Guest guest]

At 02:08 AM 5/16/2008, you wrote:

> > Of course you're worried. But the thing

> is--and the doctor should know this--you don't

> give tetanus shots in an " emergency " situation

> to those who have not been vaccinated already.

> I don't have all the details on the top of my

> head and I'm running out the door, but it's

> something to do with different kinds of tetanus

> shots. Here's the link to Sheri's webpage on tetanus:

> > http://www.wellwithin1.com/tetanus.htm

Tetanus Immune Globulin

Also want to remind you of this. If you end up

in an ER and haven't vaccinated, you will be faced with this choice.

>From plasma pooled from a variety of people who

have had tetanus vaccine. Now if you don't want

to inject into your baby why would you want a blood

product from all sorts of someones with it

in. Who are these donors? What do they do with

their bodies? What do they eat? What drugs do they use?

What about their DNA???

My personal opinion-I wouldn't risk blood

products myself. Too much unknown. (not advice as a nurse but as a person)

Sheri

http://www.univgraph.com/bayer/inserts/baytet.pdf

------------------------------------------------------------------------

Tetanus Immune Globulin (002323)

CATEGORIES:

Indications: Immunization, tetanus

Pregnancy Category C

WHO Formulary

FDA Pre 1938 Drugs

DRUG CLASS: Immune Serums; Vaccines/Antisera

BRAND NAMES: BayTet (US); Hyper-Tet (US); Hypertet (US);

HCFA JCODES: J1670 up to 250 units IM

DESCRIPTION:

Tetanus immune globulin (human)--BayTet treated with solvent/detergent is a

sterile solution of tetanus hyperimmune immune globulin for intramuscular

administration; it contains no preservative. BayTet is prepared by cold

ethanol fractionation from the plasma of donors immunized with tetanus

toxoid. The immune globulin is isolated from solubilized Cohn Fraction II.

The Fraction II solution is adjusted to a final concentration of 0.3%

tri-n-butyl phosphate (TNBP) and 0.2% sodium cholate. After the addition of

solvent (TNBP) and detergent (sodium cholate), the solution is heated to

30°C and maintained at that temperature for not less than 6 hours. After

the viral inactivation step, the reactants are removed by precipitation,

filtration and finally ultrafiltration and diafiltration. BayTet is

formulated as a 15-18% protein solution at a pH of 6.4-7.2 in 0.21-0.32 M

glycine. BayTet is then incubated in the final container for 21-28 days at

20-27°C. The product is standardized against the U.S. Standard Antitoxin

and the U.S. Control Tetanus Toxin and contains not less than 250 tetanus

antitoxin units per container.

The removal and inactivation of spiked model enveloped and non-enveloped

viruses during the manufacturing process for BayTet has been validated in

laboratory studies. Human Immunodeficiency Virus, Type 1 (HIV-1), was

chosen as the relevant virus for blood products; Bovine Viral Diarrhea

Virus (BVDV) was chosen to model Hepatitis C virus; Pseudorabies virus

(PRV) was chosen to model Hepatitis B virus and the Herpes viruses; and Reo

virus type 3 (Reo) was chosen to model non-enveloped viruses and for its

resistance to physical and chemical inactivation. Significant removal of

model enveloped and non-enveloped viruses is achieved at two steps in the

Cohn fractionation process leading to the collection of Cohn Fraction II:

the precipitation and removal of Fraction III in the processing of Fraction

II + IIIW suspension to Effluent III and the filtration step in the

processing of Effluent III to Filtrate III. Significant inactivation of

enveloped viruses is achieved at the time of treatment of solubilized Cohn

Fraction II with TNBP/sodium cholate.

CLINICAL PHARMACOLOGY:

The occurrence of tetanus in the United States has decreased dramatically

from 560 reported cases in 1947, when national reporting began, to a record

low of 48 reported cases in 1987.1 The decline has resulted from widespread

use of tetanus toxoid and improved wound management, including use of

tetanus prophylaxis in emergency rooms.2

Tetanus immune globulin supplies passive immunity to those individuals who

have low or no immunity to the toxin produced by the tetanus organism,

Clostridium tetani. The antibodies act to neutralize the free form of the

powerful exotoxin produced by this bacterium. Historically, such passive

protection was provided by antitoxin derived from equine or bovine serum;

however, the foreign protein in these heterologous products often produced

severe allergic manifestations, even in individuals who demonstrated

negative skin and/or conjunctival tests prior to administration. Estimates

of the frequency of these foreign protein reactions following antitoxin of

equine origin varied from 5%-30%.3-6 If passive immunization is needed,

human tetanus immune globulin (TIG) is the product of choice. It provides

protection longer than antitoxin of animal origin and causes few adverse

reactions.2

Several studies suggest the value of human tetanus antitoxin in the

treatment of active tetanus.7,8 In 1961 and 1962, Nation et al. ,7 using

tetanus immune globulin treated 20 patients with tetanus using single doses

of 3000 to 6000 antitoxin units in combination with other accepted clinical

and nursing procedures. Six patients, all over 45 years of age, died of

causes other than tetanus. The authors felt that the mortality rate (30%)

compared favorably with their previous experience using equine antitoxin in

larger doses and that the results were much better than the 60% national

death rate for tetanus reported from 1951 to 1954.9 Blake et al. ,10

however, found in a data analysis of 545 cases of tetanus reported to the

Centers for Disease Control from 1965 to 1971 that survival was no better

with 8000 units of TIG than with 500 units; however, an optimal dose could

not be determined.

Serologic tests indicate that naturally acquired immunity to tetanus toxin

does not occur in the United States. Thus, universal primary vaccination,

with subsequent maintenance of adequate antitoxin levels by means of

appropriately timed boosters, is necessary to protect persons among all age

groups. Tetanus toxoid is a highly effective antigen; a completed primary

series generally induces protective levels of serum antitoxin that persist

for [image] 10 years.2

Passive immunization with tetanus immune globulin may be undertaken

concomitantly with active immunization using tetanus toxoid in those

persons who must receive an immediate injection of tetanus antitoxin and in

whom it is desirable to begin the process of active immunization. Based on

the work of Rubbo,11 McComb and Dwyer,12 and Levine et al. ,13 the

physician may thus supply immediate passive protection against tetanus, and

at the same time begin formation of active immunization in the injured

individual which upon completion of a full toxoid series will preclude

future need for antitoxin.

Peak blood levels of lgG are obtained approximately 2 days after

intramuscular injection. The half-life of lgG in the circulation of

individuals with normal lgG levels is approximately 23 days.14

In a clinical study in eight healthy human adults receiving another

hyperimmune immune globulin product treated with solvent/detergent, Rabies

Immune Globulin (Human), BayRab, prepared by the same manufacturing

process, detectable passive antibody titers were observed in the serum of

all subjects by 24 hours post injection and persisted through the 21 day

study period. These results suggest that passive immunization with immune

globulin products is not affected by the solvent/detergent treatment.

INDICATIONS AND USAGE:

Tetanus immune globulin is indicated for prophylaxis against tetanus

following injury in patients whose immunization is incomplete or uncertain.

It is also indicated, although evidence of effectiveness is limited, in the

regimen of treatment of active cases of tetanus.7,8,15

A thorough attempt must be made to determine whether a patient has

completed primary vaccination. Patients with unknown or uncertain previous

vaccination histories should be considered to have had no previous tetanus

toxoid doses. Persons who had military service since 1941 can be considered

to have received at least one dose, and although most of them may have

completed a primary series of tetanus toxoid, this cannot be assumed for

each individual. Patients who have not completed a primary series may

require tetanus toxoid and passive immunization at the time of wound

cleaning and debridement.2

TABLE 1 is a summary guide to tetanus prophylaxis in wound management:

TABLE 1 Guide to Tetanus Prophylaxis in Wound Management2

History of Tetanus

Immunization (Doses) Clean, Minor Wounds All Other Wounds*

Td[image] TIG[image] Td TIG

Uncertain or less than Yes No Yes Yes

3

3 or more § No|| No No¶ No

* Such as, but not limited to, wounds contaminated with dirt, feces,

soil, and saliva; puncture wounds; avulsions; and wounds resulting from

missiles, crushing, burns and frostbite.

[image] Adult type tetanus and diphtheria toxoids. If the patient is less

than 7 years old, DT or DTP is preferred to tetanus toxoid alone. For

persons [image]7 years of age, Td is preferred to tetanus toxoid alone.

(see Dosage and Administration).

[image] Tetanus Immune Globulin (Human).

§ If only three doses of fluid tetanus toxoid have been received, a

fourth dose of toxoid, preferably an absorbed toxoid, should be given.

|| Yes if more than 10 years since the last dose.

¶ Yes if more than 5 years since the last dose. (More frequent boosters

are not needed and can accentuate side effects).

CONTRAINDICATIONS:

None known.

WARNINGS:

Tetanus immune globulin should be given with caution to patients with a

history of prior systemic allergic reactions following the administration

of human immunoglobulin preparations.

In patients who have severe thrombocytopenia or any coagulation disorder

that would contraindicate intramuscular injections, tetanus immune globulin

should be given only if the expected benefits outweigh the risks.

PRECAUTIONS:

General: Tetanus immune globulin should not be given intravenously.

Intravenous injection of immunoglobulin intended for intramuscular use can,

on occasion, cause a precipitous fall in blood pressure, and a picture not

unlike anaphylaxis. Injections should only be made intramuscularly and care

should be taken to draw back on the plunger of the syringe before injection

in order to be certain that the needle is not in a blood vessel.

Intramuscular injections are preferably administered in the anterolateral

aspects of the upper thigh and the deltoid muscle of the upper arm. The

gluteal region should not be used routinely as an injection site because of

the risk of injury to the sciatic nerve. If the gluteal region is used, the

central region MUST be avoided; only the upper, outer quadrant should be

used.16

Chemoprophylaxis against tetanus is neither practical nor useful in

managing wounds. Wound cleaning, debridement when indicated, and proper

immunization are important. The need for tetanus toxoid (active

immunization), with or without TIG (passive immunization), depends on both

the condition of the wound and the patient's vaccination history. Rarely

has tetanus occurred among persons with documentation of having received a

primary series of toxoid injections.2 See table under INDICATIONS AND

USAGE.

Skin tests should not be done. The intradermal injection of concentrated

IgG solutions often causes a localized area of inflammation which can be

misinterpreted as a positive allergic reaction. In actuality, this does not

represent an allergy; rather, it is localized tissue irritation.

Misinterpretation of the results of such tests can lead the physician to

withhold needed human antitoxin from a patient who is not actually allergic

to this material. True allergic responses to human IgG given in the

prescribed intramuscular manner are rare.

Although systemic reactions to human immunoglobulin preparations are rare,

epinephrine should be available for treatment of acute anaphylactic

reactions.

Pregnancy Category C: Animal reproduction studies have not been conducted

with tetanus immune globulin. It is also not known whether tetanus immune

globulin can cause fetal harm when administered to a pregnant woman or can

affect reproduction capacity. Tetanus immune globulin should be given to a

pregnant woman only if clearly needed.

Pediatric Use: Safety and effectiveness in the pediatric population have

not been established.

DRUG INTERACTIONS:

Antibodies in immunoglobulin preparations may interfere with the response

to live viral vaccines such as measles, mumps, polio, and rubella.

Therefore, use of such vaccines should be deferred until approximately 3

months after tetanus immune globulin administration.

No interactions with other products are known.

ADVERSE REACTIONS:

Slight soreness at the site of injection and slight temperature elevation

may be noted at times. Sensitization to repeated injections of human

immunoglobulin is extremely rare.

In the course of routine injections of large numbers of persons with

immunoglobulin there have been a few isolated occurrences of angioneurotic

edema, nephrotic syndrome, and anaphylactic shock after injection.

OVERDOSAGE:

Although no data are available, clinical experience with other

immunoglobulin preparations suggests that the only manifestations would be

pain and tenderness at the injection site.

DOSAGE AND ADMINISTRATION:

Routine prophylactic dosage schedule:

Adults and Children 7 Years and Older: Tetanus immune globulin, 250 units

should be given by deep intramuscular injection (see PRECAUTIONS). At the

same time, but in a different extremity and with a separate syringe,

Tetanus and Diphtheria Toxoids Adsorbed (For Adult Use) (Td) should be

administered according to the manufacturer's package insert. Adults with

uncertain histories of a complete primary vaccination series should receive

a primary series using the combined Td toxoid. To ensure continued

protection, booster doses of Td should be given every 10 years.2

Children Less Than 7 Years Old: In small children the routine prophylactic

dose of tetanus immune globulin may be calculated by the body weight (4.0

units/kg). However, it may be advisable to administer the entire contents

of the vial or syringe of tetanus immune globulin (250 units) regardless of

the child's size, since theoretically the same amount of toxin will be

produced in the child's body by the infecting tetanus organism as it will

in an adult's body. At the same time but in a different extremity and with

a different syringe, Diphtheria and Tetanus Toxoids and Pertussis Vaccine

Adsorbed (DTP) or Diphtheria and Tetanus Toxoids Adsorbed (For Pediatric

Use) (DT), if pertussis vaccine is contraindicated, should be administered

per the manufacturer's package insert.

Note: The single injection of tetanus toxoid only initiates the series for

producing active immunity in the recipient. The physician must impress upon

the patient the need for further toxoid injections in 1 month and 1 year.

Without such, the active immunization series is incomplete. 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 immune globulin.2

(See TABLE 1.)

Available evidence indicates that complete primary vaccination with tetanus

toxoid provides long lasting protection [image] 10 years for most

recipients. Consequently, after complete primary tetanus vaccination,

boosters--even for wound management--need be given only every 10 years when

wounds are minor and uncontaminated. For other wounds, a booster is

appropriate if the patient has not received tetanus toxoid within the

preceding 5 years. Persons who have received at least two doses of tetanus

toxoid rapidly develop antibodies.2 The prophylactic dosage schedule for

these patients and for those with incomplete or uncertain immunity is shown

in TABLE 1.

Since tetanus is actually a local infection, proper initial wound care is

of paramount importance. The use of antitoxin is adjunctive to this

procedure. However, in approximately 10% of recent tetanus cases, no wound

or other breach in skin or mucous membrane could be implicated.17

Treatment of Active Cases of Tetanus

Standard therapy for the treatment of ctive tetanus including the use of

tetanus immune globulin must be implemented immediately. The dosage should

be adjusted according to the severity of the infection.7,8

Parenteral drug products should be inspected visually for particulate

matter and discoloration prior to administration, whenever solution and

container permit. They should not be used if particulate matter and/or

discoloration are present.

Directions for Syringe Usage

1. Remove the prefilled syringe from the package. Lift syringe by

barrel, not by plunger.

2. Twist the plunger rod clockwise until the threads are seated.

3. With the rubber needle shield secured on the syringe tip, push the

plunger rod forward a few millimeters to break any friction seal

between the rubber stopper and the glass syringe barrel.

4. Remove the needle shield and expel air bubbles.

5. Proceed with hypodermic needle puncture.

6. Aspirate prior to injection to confirm that the needle is not in a

vein or artery.

7. Inject the medication.

8. Withdraw the needle and dispose or destroy it.

REFERENCES:

1. Tetanus--United States, 1987 and 1988, MMWR 39(3): 37-41, 1990.

2. Diphtheria, Tetanus, and Pertussis: Recommendations for Vaccine Use and

Other Preventive Measures. Recommendations of the Immunization Practices

Advisory Committee (ACIP). MMWR 40 (RR-10): 1-28, 1991.

3. Moynihan NH: Tetanus prophylaxis and serum sensitivity tests. Br Med J

1:260-4, 1956.

4. Scheibel I: The uses and results of active tetanus immunization. Bull

WHO 13:381-94, 1955.

5. Edsall G: Specific prophylaxis of tetanus. JAMA 171(4):417-27, 1959.

6. Bardenwerper HW: Serum neuritis from tetanus antitoxin. JAMA

179(10):763-6, 1962.

7. Nation NS, Pierce NF, Adler SJ, et al: Tetanus: the use of human

hyperimmune globulin in treatment. Calif Med 98(6):305-6, 1963.

8. Ellis M: Human antitetanus serum in the treatment of tetanus. Br Med J

1(5338):1123-6, 1963.

9. Axnick NW, ER: Tetanus in the United States: A review of the

problem. Am J Public Health 47(12):1493-1501, 1957.

10. Blake PA, Feldman RA, Buchanan TM, et al: Serologic therapy of tetanus

in the United States, 1965-1971. JAMA 235(1):42-4, 1976.

11. Rubbo SD: New approaches to tetanus prophylaxis. Lancet 2(7461):449-53,

1966.

12. McComb JA, Dwyer RC: Passive-active immunization with tetanus immune

globulin (human). N Engl J Med 268(16):857-62, 1963.

13. Levine L, McComb JA, Dwyer RC, et al: Active-passive tetanus

immunization; choice of toxoid, dose of tetanus immune globulin and timing

of injections. N Engl J Med 274(4):186-90, 1966.

14. Waldmann TA, Strober W, Blaese RM: Variations in the metabolism of

immunoglobulins measured by turnover rates. In Merler E (ed.):

Immunoglobulins: biologic aspects and clinical uses. Washington, DC, Nat

Acad Sci, 1970, p. 33-51.

15. McCracken GH Jr., Dowell DL, Marshall FN: Double-blind trial of equine

antitoxin and human immune globulin in tetanus neonatorum. Lancet

1(7710):1146-9, 1971.

16. Recommendations of the Immunization Practices Advisory Committee

(ACIP): General recommendations on immunization. MMWR 38(13): 205-14;

219-27, 1989.

17. Tetanus-Rates by year, United States, 1955-1984. Annual Summary 1984.

MMWR 33 (54):61, 1986.

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HOW SUPPLIED:

Storage: Store at 2-8°C (36-46°F). Solution that has been frozen should not

be used.