Tetanus Immunity and Epidemiology in Australia, 1993-2010

Background: This study evaluates trends in tetanus immunity and epidemiology over the last two decades in Australia, drawing on two national serological surveys and national tetanus morbidity data, to justify current Australian adult tetanus booster recommendations. Methods: We compare tetanus immunity level between two national serosurveys, and examine incidence trends using the most accurate estimation of the true number of cases by correcting for under-ascertainment. Results: Tetanus immunity in people aged <60 years is high, but the elderly, particularly the female elderly, may not be adequately protected. Over the past twenty years older people have regularly accounted for the highest number of tetanus cases, with an increasing proportion of cases. Conclusion: Despite a positive decrease in tetanus incidence, there remains a significant burden in the elderly population of an entirely preventable disease. Supplying a funded booster dose of dTpa at 65 years would be, potentially, an effective strategy to prevent tetanus cases in Australia.