Tetanus immunity in long-term care facilities

OBJECTIVES: To investigate the correlates of tetanus immunity in the elderly residing in a long-term care facility in Hawaii. DESIGN: Cross-sectional. SETTING: A nursing home in Honolulu, Hawaii. PARTICIPANTS: Sixty subjects aged 65 and older: 30 men and 30 women. MEASUREMENTS: The interview included demographic information, immunization history, military service information, and other potential risk factors for tetanus. Serum tetanus antibody titers were measured. RESULTS: The data showed that 76.7% (46/60) had adequate tetanus titers. This is in stark contrast to previous studies, which have reported immunity rates of 27% to 46% in similar populations. There were significant associations between immunity and prior history of military service. There were no significant associations between immunity and past history of immunization, education, socioeconomic status, or sex. CONCLUSION: History of immunization from patients, families, or medical charts may be unreliable indicators of tetanus immunity. Recognizing patterns of and barriers to immunization could have important consequences for public health policy in long-term care institutions.