Summary
Data collected over a 15-year period concerning the side effects directly reported following administration of Tetanol were evaluated and it was found that the tetanus vaccination exhibited an extremely high degree of tolerance, with only 27 cases of side effects for 1 million doses.
In over 80% of those cases with side effects the intolerance took the form of a painful reddening and/or swelling at the site of injection. This reaction to the vaccination, though not uncommon, was thus greater than is to be expected. General reactions, particularly malaise and an increase in body temperature, accounted for 10% of the cases reported; 3% involved skin reactions beyond the injection site. Symptoms involving the cardiac, circulatory, respiratory, locomotor, or nervous system occurred in fewer than 3 cases per 1 million doses, i.e., in fewer than 5% of the reported cases. It proved highly improbable that an allergic-anaphylactic or anaphylactoid reaction was involved and the complete picture of anaphylactic shock was never observed.
Young and middle-aged adults with several tetanus pre-vaccinations accounted for the majority of side effects reported and in most cases hyperimmunization was suspected as a cause. As they were mainly restricted to the site of application and in 75% of cases occurred within 2–48 h, they can be interpreted as type III reactions (Arthus type). Furthermore it can be assumed that other causes of the reactions will have included unintentional intravascular and subcutaneous administration. Finally, one should also allow for the possibility of disease having coincided with the vaccination — especially in those cases where the reaction was not limited to the application site.
More than 90% of all those adverse reactions occurring following a tetanus vaccination could thus be avoided by correct vaccination techniques and detailed vaccination anamnesis.
Similar content being viewed by others
Literatur
Abt W (1980) Unfallanalyse 1980. Schriftreihe des Hauptverbandes der gewerblichen Berufsgenossenschaften e.V., S 61–73
Russel A (1960) Allergy to tetanus toxoid. JAMA 174/9:1220
Baraff L, Cody C, James Ch (1984) DTP — Associated reactions: An analysis by injection site, manufacturer, prior reactions, and dose. Pediatrics 73/1:31–36
Bösel B, Hartung K (Hrsg) (1984) Tetanus. In Praktikum des Infektions- und Impfschutzes, 6. Auflage, Hoffmann, Berlin, S 328–329
Brindle MJ, Twyman DG (1962) Allergic reactions to tetanus toxoid. Brit Med J 1/5285:1116–1117
Brit Med J (1974) Reactions to tetanus toxoid. Brit Med J 1/5897:48
Cockshott WP, Thompson GT, Howlett LJ, Seeley ET (1982) Intramuscular or intralipomatous injections? New Engl J Med 307/6:356–358
David D, Zehntner B (1971) Tetanusimpfung: Nebenwirkungen bei verschiedenen Impflokalisationen und Modus. Schweiz Med Wochenschr 101/29:1055–1057
Dengler R (1978) Zentralnervöse Komplikationen nach Tetanusauffrischimpfung. Münch Med Wochenschr 120/20:707–708
Dieckhöfer K, Scholl R, Wolf R (1978) Neurologische Störungen nach Tetanusimpfung. Med Welt 29/44:1710–1712
Edsall G, Elliot M, Peebles T, Levine L, Eldred M (1967) Excessive use of tetanus toxoid boosters. JAMA 202/1:111–113
Ehrengut W (1970) Reaktionen der Wundstarrkrampfimpfung. Dtsch Med Wochenschr 95/35:1799–1800
Fardon D (1967) Unusual reactions to tetanus toxoid. JAMA 199/2:125–126
Fenichel GM (1983) Neurologic complications of tetanus toxoid. Arch Neurol Vol 40:390
Goto N, Akama K (1982) Histopathological studies of reactions in mice injected with aluminium — adsorbed tetanus toxoid. Microbiol Immunol 26/12:1121–1132
Holzner A (1978) Immunstatus nach Tetanus-Impfung. Fortschr Med 96/13:680–683
Hopf H-Ch (1980) Guillain-Barré-Syndrom nach Tetanus-Schutz-Impfung. Akt Neurol 7:195–200
Jacobs R, Lowe R, Lanier B (1982) Adverse reactions to tetanus toxoid. JAMA 247/1:40–42
Kittler F, Schmith P, Hefley B, Cazort A (1966) Reactions to tetanus toxoid. Southern Med J 59:149–153
König W, Bohn A (1983) Allergie-Anaphylaxie. In: Vorlaender K-O (Hrsg) Immunologie. 2. Auflage, Thieme, Stuttgart New York, S 146
Kuhlwein A, Küchmeister B (1983) Tetanus-Hyperimmunisierungsphänomen und Wehrdienstfähigkeit. Wehrmed Monatsschr 8:320–325
Levine L, Ipsen J, McComb J (1961) Adult immunization-preparation and evaluation of combined fluid tetanus and diphtheria toxoids for adults use. Am J Hyg 73:20–35
McComb J, Levine L (1961) Adult immunization — II. Dosage reduction as a solution to increasing reactions to tetanus toxoid. New Engl J Med 265/23:1152–1153
Myers MG, Beckman ChW, Vosdingh RA, Hankins WA (1982) Primary immunization with tetanus and diphtheria toxoids. JAMA 248/19:2478–2480
Peebles TC, Levine L, Eldred MC, Edsal G (1969) Tetanustoxoid emergency boosters. New Engl J Med 280/11:575–581
Quast U, Werb M (1980) Arzneimittelsicherheit durch Erfassung von Nebenreaktionen mit Computer. Diagn Intensivther 5:76–79
Quast U, Hennessen W, Widmark RM (1979) Mono- and polyneuritis after tetanus vaccination. Develop biol Standard 43:25–32
Reinstein L, Pargament JM, Goodman JS (1982) Peripheral neuropathy after multiple tetanus toxoid injections. Arch Phys Med Rehabil 63:332–334
Relihan M (1969) Reactions to tetanus toxoid. J Irish Med Ass 62/390:430–434
Schlenska GK (1977) Unusual neurological complications following tetanus toxoid administration. J Neurol 576:1–4
Schneider CH (1964) Reactions to tetanus toxoid: A report of five cases. Med J Aust 2:303–305
Slater DN, Underwood JCE, Durrant TE, Gray T, Hopper IP (1982) Aluminum hydroxide granulomas: light and electron microscopic studies and X-ray microanalysis. Brit J Dermat 107:103–108
Spiess H (1973) Anaphylaktische Reaktionen nach aktiver Tetanus-Immunisierung. Dtsch Med Wochenschr 98/13:682
Staak M, Wirth E (1973) Zur Problematik anaphylaktischer Reaktionen nach aktiver Tetanus-Immunisierung. Dtsch Med Wochenschr 98/3:110–111
Staak M (1973) Stellungnahme zu: Anaphylaktische Reaktionen nach aktiver Tetanus-Immunisierung von Spiess. Dtsch Med Wochenschr 98/13:682
Wegmann A, Heiz R (1979) Lokale Reaktionen nach wiederholten Tetanusimpfungen. Schweiz Med Wochenschr 109/38:1409–1410
Zaloga GP, Chernow B (1982) Life-threatening anaphylactic reactions to tetanus toxoid. Ann Allergy 49:107–108
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Korger, G., Quast, U. & Dechert, G. Tetanusimpfung — Verträglichkeit und Vermeidung von Nebenreaktionen. Klin Wochenschr 64, 767–775 (1986). https://doi.org/10.1007/BF01732184
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01732184