Currently tetanus vaccinations are administered in the course of one-shot and two-shot vaccines (diphtheria), three-shot vaccines (Diphtheria-Pertussis-Tetanus) or five and six-shot vaccines, respectively. Detoxified tetanus toxin which is bound to aluminum hydroxide is used. Depending on the combination and the manufacturer, the vaccine also contains thimerosal, phenoxyethanol, formaldehyde and aluminum, among others. We recommend abstaining from vaccinations if there is an allergy against thimerosal, formaldehyde or aluminum hydroxide.
Immunity
If a person survives tetanus, they do not becomeimmune. Today tetanus has become very rare in Germany. However, this is attributable not only to the vaccine but also to better living conditions and agricultural mechanization.
A diagram in Dr. Buchwald’s book serves as an example. The grey bar indicates the years during which mass vaccinations were conducted.
Germany (as a whole)
Fig.42: Number of deaths caused by tetanus since 1949
Source: Federal Statistical Office [Statistisches Bundesamt], Wiesbaden, Germany, Group VII D
An American trial determined that themortality rate was 6% for those persons who were partially vaccinated (1-2 vaccine dosages); the rate for those who had not been vaccinated was 15%. There were no deaths among persons who contracted the disease who had undergone a complete basic immunization once in their life (“Impfen: Routine oder Individualisation Eine Standortbestimmung aus hausärztlicher Sicht, 2. Auflage 2000, Arbeitsgruppe für differnenzierte Impfungen, S. 16” [Vaccinations: Routine or Individualization. Taking stock from a family doctor’s perspective, 2nd edition 2000, Commission for differentiated vaccinations, pge 16])
Repeatedly there have been incidences in which people who were vaccinated contracted tetanus despite their having high anti-tetanus titers. Thus elevated antitoxin titers do not provide information on protection.(Crone NE, Reder AT.,Severe tetanus in immunized patients with high anti-tetanus titers.Neurology. 1992 Apr;42(4):761-4. /Hahn BJ, Erogul M, Sinert R., Case report of tetanus in an immunized, healthy adult and no point of entry.J Emerg Med. 2004 Oct;27(3):257-60./ J Fam Pract. 1997 Mar;44(3):299-303.Elevated antitoxin titers in a man with generalized tetanus, Pryor T, Onarecker C, Coniglione T.)
A more recent trial states that the risk of contracting tetanus after an injury for people who have not been vaccinated is approximately 0.5 - 2 per million. (De Melker HE, Steyerberg EW: Doelmatigheid van tetanusimmunoglobuline bij een verwonding: toediening vaak onnodig [Function of tetanus immunoglobulin in case of injury: administration often unnecessary]. Ned Tijdschr Geneeskd 2004 Feb 28;148(9):429-33.)
An interesting trial was conducted in Finland in which cases of tetanus between 1969 and 1985 were investigated. A total of 106 persons had contracted tetanus; five were children. Four of the five children had been completely immunized against tetanus. (Luisto M, Iivanainen M.:Tetanus of immunized children.Dev Med Child Neurol. 1993 Apr;35(4):351-5.).
Side effects, vaccine complications and vaccine injuries
Localized reactions
Frequently adverse effects of tetanus vaccinations consist in local reactions (pain, reddening and swelling of the injection site). Presumably this is caused by the aluminum hydroxide or other absorbent materials present in the vaccine. In a trial with Swedish schoolchildren, three quarters of the children experienced local discomfort after they had received booster shots.(Blennow, Gangström, Steandell :adverse reactions after diphtheria-tetanus booster in 10 -year old schoolchildren in relation to the type of vaccine given for the primary vaccination. Vaccine 1994,12(4) Similarly there are local reactions to thimerosal. Frequently abscesses and granulomas with swelling of the lymph nodes can occur. However, they subside again after several weeks.
Vaccination disease accompanied by fever, arthralgia, exanthema or adenitis occur in 5-30% of vaccinations (Impfen: Routine oder Individualisation Eine Standortbestimmung aus hausärztlicher Sicht, 2. Auflage 2000, Arbeitsgruppe für differnenzierte Impfungen, S. 18)
Allergic reactions
Immediate allergic reactions occur can occur after the vaccination, including allergic shock, usually if there is a combination of diphtheria and pertussis. But this tends to be rare. What occurs more frequently is delayed reactions, such as urticaria, itchiness or even asthma. In a trial conducted by Hurwitz and Morgenstern the authors were able to show that children (2 months to 16 years of age) who had been vaccinated (DPT or tetanus) suffered from asthma twice as often as those children who had not been vaccinated. Moreover, the probability of an allergic disease was increased by 63% in children who had been vaccinated. This connection was obvious mainly in children between 5 and 10 years of age. This correlation was particularly evident in children who were between 5 and 10 years of age. Even if the number of children who had not been vaccinated was relatively small in the trial, these numbers should be borne in mind.(Hurwitz EL, Morgenstern H.:Effects of diphtheria-tetanus-pertussis or tetanus vaccination on allergies and allergy-related respiratory symptoms among children and adolescents in the United States.J Manipulative Physiol Ther. 2000 Feb;23(2):81-90.)
A new trial conducted by Adriano Mari, an allergist (Mari A: Is there a causative role for tetanus toxoid vaccination in the development of allergy-like symptoms and in the increasing prevalence of atopic diseases? Med Hypotheses 2004,63(5):875-86) shows a correlation between tetanus vaccinations and allergic diseases: In "Medical Hypotheses" he proceeds on the current assumption that the increase in allergic and auto-immune disease has the same underlying mechanism, i.e. a general dysfunctional regulation of the immune system, whereby IgG-auto antibodies are established against IgE-receptors (FcepsilonRIalpha) on mast cells. These receptors have similar antigen features such as tetanus toxoid (Horn MP, Gerster T, Ochsenberger B, Derer T, Kricek F, Jouvin MH, Kinet JP, Tschernig T, Vogel M, Stadler BM, Miescher SM:Human anti-FcepsilonRIalpha autoantibodies isolated from healthy donors cross-react with tetanus toxoid., Eur J Immunol 1999, 29(4):1139-48). The injection of tetanus toxoid in early childhood could thus stimulate distribution of mast cell mediators and TH2 cytokines via the formation of IgG auto-antibodies and thus lead to a chronic “allergic” inflammation in various tissues.
Neurological reactions
Occasionally there are neurological complications after a tetanus vaccination (or DPT), such as neuralgia, Guilain-Barré-Syndrome or encephalitis. Damage to the peripheral nerves can occur occasionally, and also inflammation of the cranial nerves, polyneuropathies. But this occurs only rarely.
Tetanus-Impfung
Impfstoff
Die Tetanus-Impfung wird heute im Rahmen der Einfach-, Zweifach-Impfung(mit Diphterie),der Dreifach-Impfung (Diphterie-Pertussis-Tetanus) oder der 5 bzw. 6 fach Impfung verabreicht. Es handelt sich um entgiftetes Tetanustoxin, das an Aluminiumhydroxid gebunden ist. Je nach Kombination und Hersteller enthält der Impfstoff zusätzlich Thiomersal, Phenoxyäthanol, Formaldehyd, Aluminium u.a.
Das Überstehen der Tetanuserkrankung hinterlässt keine Immunität. In Deutschland ist Tetanus heute eine sehr seltene Erkrankung. Diese Tatsache ist aber nicht nur auf die Impfung, sondern auch auf verbesserte Lebensbedingungen und die Mechanisierung der Landwirtschaft zurückzuführen. Siehe Graphik.
In einer amerikanischen Studie wurde festgestellt, dass die Mortalität der teilweise geimpften(1-2 Impfdosen) bei 6% lag, die der Ungeimpften bei 15%. Keine Todesfälle gab es bei Erkrankten, die einmal im Leben eine komplette Grundimmunisierung durchgemacht hatten(Impfen: Routine oder Individualisation Eine Standortbestimmung aus hausärztlicher Sicht, 2. Auflage 2000, Arbeitsgruppe für differnenzierte Impfungen, S. 16)
Es gibt immer wieder Erkrankungsfälle, in denen geimpfte Personen trotz hoher Antikörpertiter an Tetanus erkranken . Die Höhe der Antikörper sagt also nichts über den Schutz aus.(Crone NE, Reder AT. ,Severe tetanus in immunized patients with high anti-tetanus titers.Neurology. 1992 Apr;42(4):761-4. /Hahn BJ, Erogul M, Sinert R., Case report of tetanus in an immunized, healthy adult and no point of entry.J Emerg Med. 2004 Oct;27(3):257-60./ J Fam Pract. 1997 Mar;44(3):299-303.Elevated antitoxin titers in a man with generalized tetanus, Pryor T, Onarecker C, Coniglione T.)
In einer neueren Studie geht man davon aus, dass das Tetanus-Risiko Ungeimpfter nach einer Verletzung bei etwa 0,5 - 2 pro Millionen liegt. (De Melker HE, Steyerberg EW: Doelmatigheid van tetanusimmunoglobuline bij een verwonding: toediening vaak onnodig [Function of tetanus immunoglobulin in case of injury: administration often unnecessary]. Ned Tijdschr Geneeskd 2004 Feb 28;148(9):429-33.)
Eine interessante Untersuchung wurde in Finnland durchgeführt. Man untersuchte die Tetanusfälle zwischen 1969 und 1985. Insgesamt erkrankten 106 Personen an Tetanus, davon 5 Kinder.4 der 5 Kinder waren vollständig gegen Tetanus geimpft (Luisto M, Iivanainen M.:Tetanus of immunized children.Dev Med Child Neurol. 1993 Apr;35(4):351-5.).
Nebenwirkungen, Impfkomplikationen und Impfschäden der Tetanusimpfung
Lokalreaktionen
Häufig kommt es als Nebenwirkung der Tetanus Impfung zu örtlichen Reaktionen(Schmerzen, Rötung und Schwellung der Einstichstelle). Ursache ist hier vermutlich das im Impfstoff vorhandene Aluminiumhydroxid oder andere Adsorbentien. In einer Studie mit schwedischen Schulkindern traten bei 3/4 der Kinder lokale Beschwerden nach der Auffrischungsimpfung auf.(Blennow, Gangström, Steandell :adverse reactions after diphteria-tetanus booster in 10 -year old schoolchildren in relation to the type of vaccine given for the primary vaccination. Vaccine 1994,12(4) Ebenso kommen Lokalreaktionen auf Thiomersal vor. Häufig kommt es auch zu Abzsessen, Granulomen mit Schwellungen der Lymphknoten, die jedoch nach mehreren Wochen wieder abklingen.
Vaccination disease accompanied by fever, arthralgia, exanthema or adenitis occur in 5-30% of vaccinations (Impfen: Routine oder Individualisation Eine Standortbestimmung aus hausärztlicher Sicht, 2. Auflage 2000, Arbeitsgruppe für differnenzierte Impfungen, S. 18)
Allergic reactions
Immediate allergic reactions occur can occur after the vaccination, including allergic shock, usually if there is a combination of diphtheria and pertussis. But this tends to be rare. What occurs more frequently is delayed reactions, such as urticaria, itchiness or even asthma. In a trial conducted by Hurwitz and Morgenstern the authors were able to show that children (2 months to 16 years of age) who had been vaccinated (DPT or tetanus) suffered from asthma twice as often as those children who had not been vaccinated. Moreover, the probability of an allergic disease was increased by 63% in children who had been vaccinated. This connection was obvious mainly in children between 5 and 10 years of age. This correlation was particularly evident in children who were between 5 and 10 years of age. Even if the number of children who had not been vaccinated was relatively small in the trial, these numbers should be borne in mind.(Hurwitz EL, Morgenstern H.:Effects of diphtheria-tetanus-pertussis or tetanus vaccination on allergies and allergy-related respiratory symptoms among children and adolescents in the United States.J Manipulative Physiol Ther. 2000 Feb;23(2):81-90.)
A new trial conducted by Adriano Mari, an allergist (Mari A: Is there a causative role for tetanus toxoid vaccination in the development of allergy-like symptoms and in the increasing prevalence of atopic diseases? Med Hypotheses 2004,63(5):875-86) shows a correlation between tetanus vaccinations and allergic diseases: In "Medical Hypotheses" he proceeds on the current assumption that the increase in allergic and auto-immune disease has the same underlying mechanism, i.e. a general dysfunctional regulation of the immune system, whereby IgG-auto antibodies are established against IgE-receptors (FcepsilonRIalpha) on mast cells. These receptors have similar antigen features such as tetanus toxoid (Horn MP, Gerster T, Ochsenberger B, Derer T, Kricek F, Jouvin MH, Kinet JP, Tschernig T, Vogel M, Stadler BM, Miescher SM:Human anti-FcepsilonRIalpha autoantibodies isolated from healthy donors cross-react with tetanus toxoid., Eur J Immunol 1999, 29(4):1139-48). The injection of tetanus toxoid in early childhood could thus stimulate distribution of mast cell mediators and TH2 cytokines via the formation of IgG auto-antibodies and thus lead to a chronic “allergic” inflammation in various tissues.
Neurological reactions
Occasionally there are neurological complications after a tetanus vaccination (or DPT), such as neuralgia, Guilain-Barré-Syndrome or encephalitis. Damage to the peripheral nerves can occur occasionally, and also inflammation of the cranial nerves, polyneuropathies. But this occurs only rarely.
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