Tetanus antitoxin levels and cutaneous anergy in hemodialysis patients in two university hospitals in Iran

Background: The global incidence of tetanus is about 1 million cases annually. Tetanus antibody values decrease with age. Some patients with humoral immune deficiencies may not respond adequately to tetanus toxoid vaccination. The incidence of infectious disease is increased in patients with chronic renal failure. The purpose of this study was to determine tetanus antitoxin level and cutaneous anergy test in hemodialysis patients. Materials and methods: A cross sectional study was performed on 44 hemodialysis patients who had been on dialysis thrice a week for at least 2 months. Quantitation of tetanus-specific antibodies was achieved by ELISA technique. Then, for Manteaux test 0.1ml of 1/10 saline diluted solution of tetanus and diphtheria toxoid was injected intradermally to the volar surface of the shunt-free arm. Induration was recorded 48-72h and 7-9 days after the injection. Results: Twenty-eight (64%) patients had induration ?5mm in 48-72h, classified as non-responsive, whereas 16 (36%) had induration ?5mm that was classified as positive test (NS). There was no significant correlation between age, sex, duration of dialysis, frequencies of dialysis , history of tetanus-diphtheria vaccination and cutaneous anergy test. Of 44 patients, 34(77.3%) had antibody level of < 0.01 IU/ml, 8 (18.2%) between 0.01-0.1 IU/ml and 2 (4.5%) had an antibody level of ?0. 1 IU/ml . There was no significant correlation between age, sex, duration of dialysis, frequencies of dialysis, history of tetanus-diphtheria vaccination, and tetanus antitoxin levels. There was a significant difference betweeninduration size of anergy test results recorded on two separate observations (48-72h and 7-9 days after the test) (p < 0.05). Conclusion: Our results indicate that immunization history was not consistent with protective antibody level, so monitoring immunization status and administering the tetanus vaccine in hemodialysis patients are required.