Adult booster vaccinations offer no added protection against tetanus, diphtheria
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Adults do not need to receive tetanus or diphtheria booster shots if they have completed the childhood vaccination series, according to the results of an observational cohort study.
These findings add to earlier research conducted in 2016 by Mark K. Slifka, PhD, professor at the Oregon Health & Science University School of Medicine and the Oregon National Primate Research Center, and colleagues. That research, which was published in Clinical Infectious Diseases, found that 97% of adults had protective levels of immunity to tetanus and diphtheria.
In the present study, Slifka and colleagues aimed to determine if this level of immunity would translate into protective immunity at the population level. To that end, they performed an observational cohort study based on WHO case reports to assess the incidence of tetanus and diphtheria among 31 North American and European countries that either do or do not routinely vaccinate adults.
The study demonstrated no significant decrease in tetanus incidence rates in countries that vaccinate adults every 5 to 20 years compared with countries that do not routinely vaccinate adults for tetanus or diphtheria (RR = 0.78; 95% CI, 0.36-1.70). Additionally, they found that the risk of developing diphtheria was greater in countries that vaccinate adults due to the inclusion of Latvia, a country with poor vaccination coverage (P < .001). However, when Latvia was excluded, there was no difference in diphtheria incidence between the two groups (RR = 2.46; 95% CI, 0.54-11.23).
“If booster vaccinations are needed for protection, then we would have predicted a higher rate of these two diseases among people living in countries that don’t routinely vaccinate adults,” Slifka said. “Instead, we found no significant difference between countries that vaccinate adults compared to those that never recommend vaccinating adults after they have completed their childhood vaccination series.”
This indicates that decreasing immunity in the absence of booster vaccination is not a concern, according to Slifka. He added that this work supports the WHO guidelines, which do not recommend routine booster vaccination of adults who have completed their childhood vaccination series.
“Currently, the Advisory Committee on Immunization Practices (ACIP) recommends decennial booster vaccination for adults, whereas the WHO does not recommend adult booster vaccination against tetanus once the childhood vaccination series has been completed,” Slifka concluded. “We are hoping that this new evidence can be used to re-visit our current adult vaccination schedule with the goal of harmonizing the recommendations of the ACIP and the WHO. If the WHO guidelines were to be adopted, we could save approximately $1 billion per year in health care costs in the United States alone.” – by Caitlyn Stulpin
Disclosure: Slifka reports no relevant financial disclosures.
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Slifka AM, et al. Clin Infect Dis. 2020;doi:10.1093/cid/ciaa017.
Hammarlund E, et al. Clin Infect Dis. 2020;doi: 10.1093/cid/ciw066.
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