Written by Joyce Smith, BS. Study shows that completion of Childhood Vaccination Series provides lifetime protection against diphtheria and tetanus, and may reduce the need for routine adult booster vaccinations.
Vaccination schedules have been modified substantially over time. In 1955, the recommendation in the US for the adult tetanus and diphtheria booster vaccination was every three years 1. It was increased to every five years in 1964 and in 1966 adjusted to once every ten years 2, where it has remained for over half a century. However, the World Health Organization (WHO) does not recommend a booster vaccine following the completion of the childhood vaccination series 3, 4, a recommendation that has been followed by at least ten European countries. It is an interesting fact that most tetanus and diphtheria –related cases and deaths in industrialized nations are occurring among vaccinated or under vaccinated individuals 5,6. While studies have shown that a long-lived antibody response to both tetanus and diphtheria vaccines exists, there is no evidence that routine adult booster vaccinations affect the incidence rates of either disease.
Slifka and colleagues conducted an observational cohort study 7 based on WHO case reports from 2001 to 2016 to compare the incidence of tetanus and diphtheria in 31 North American and European countries that either do or do not recommend adult booster vaccination. They found no significant decline in disease rates of tetanus between Group One (countries that vaccinate adults every 5–20 years) and Group Two (countries that do not routinely vaccinate adults for tetanus and diphtheria). The incidence of diphtheria was shown to have increased in Group One due to the inclusion of Latvia (a country with poor vaccination coverage, P<0.001); however, when Latvia was excluded, there was no difference in diphtheria incidence between Groups One and Two. Thus, after reviewing incident tetanus and diphtheria data equivalent to more than 11 billion person years, the team concluded that there was no longer a benefit in giving adult booster vaccinations against tetanus or diphtheria. These results support the WHO position on adult booster vaccination, and provide strong evidence that the childhood vaccination series can provide a lifetime of protection against both diseases. The research team suggests that the tetanus and diphtheria vaccines could potentially join the ranks of at least nine other vaccines (measles, mumps, rubella, polio, hepatitis A virus, hepatitis B virus, Hemophilus influenza B, rotavirus, and human papillomavirus), all of which do not requiring routine adult vaccinations.
These results should not be applied to countries with low vaccination coverage, or who have aged-based gaps in coverage or poor health infrastructure. If the US alone, which vaccinates 15.2 million adults annually, were to adopt the WHO guidelines for vaccination, the risk-to-benefit ratio of immunization would dramatically improve. We could anticipate a decrease in vaccination associated adverse events (including a decrease in approximately 13,200 medically attended vaccination site reactions), a decrease in 800 cases of cellulitis, and up to 73 cases of ulcerated lesions. Furthermore, the 1.03 billion annual dollar savings derived from removing the adult booster vaccine could be directed towards vaccine programs for vulnerable populations such as pregnant women, recent immigrants from countries with poor vaccination coverage, and under vaccinated populations such as the elderly who may have incomplete or no known vaccination schedules. It is these populations that pose the greatest risk. 5,6.
Source: Slifka, Ariel M., Byung Park, Lina Gao, and Mark K. Slifka. “Incidence of Tetanus and Diphtheria in Relation to Adult Vaccination Schedules.” Clinical Infectious Diseases (2020).
© The Author(s) 2020
Posted March 10, 2020.
Joyce Smith, BS, is a degreed laboratory technologist. She received her bachelor of arts with a major in Chemistry and a minor in Biology from the University of Saskatchewan and her internship through the University of Saskatchewan College of Medicine and the Royal University Hospital in Saskatoon, Saskatchewan. She currently resides in Bloomingdale, IL.
References:
- Pediatrics AAo. Report of the Committee on the Control of Infectious Diseases. Report of the Committee on the Control of Infectious Diseases. 1955.
- Peebles TC, Levine L, Eldred MC, Edsall G. Tetanus-toxoid emergency boosters: a reappraisal. New England Journal of Medicine. 1969;280(11):575-581.
- Organization WH. Diphtheria vaccine: WHO position paper–August 2017–Vaccin antidiphtérique: Note de synthèse de l’OMS–août 2017. Weekly Epidemiological Record= Relevé épidémiologique hebdomadaire. 2017;92(31):417-435.
- Organization WH. Summary of WHO Position Papers-Recommendations for Route Immunization. 2019.
- Gardner P. Issues related to the decennial tetanus-diphtheria toxoid booster recommendations in adults. Infectious disease clinics of North America. 2001;15(1):143-153.
- Kantsone I, Lucenko I, Perevoscikovs J. More than 20 years after re-emerging in the 1990s, diphtheria remains a public health problem in Latvia. Eurosurveillance. 2016;21(48).
- Slifka AM, Park B, Gao L, Slifka MK. Incidence of Tetanus and Diphtheria in Relation to Adult Vaccination Schedules. Clinical Infectious Diseases. 2020.
